Surveillance of urothelial carcinoma

Abstract

BACKGROUND: Previous investigators have detected shifts to lower stages at diagnosis for renal cell carcinoma and prostate cancer. The authors investigated whether a similar pattern is seen for urothelial carcinomas of the bladder, ureter, and renal pelvis and sought to identify changes in cancer grade and survival trends from 1993 to 2005. METHODS: The National Cancer Data Base (NCDB) collects data on approximately 75% of all newly diagnosed cancer cases annually. The authors queried the database for cases of urothelial carcinomas diagnosed in 1993‐2005 in patients aged 18 years and older. All cancer stage data were forward converted to the sixth edition of the American Joint Committee on Cancer staging definitions. RESULTS: A total of 334,480 bladder cancer cases, 15,105 renal pelvis cancer cases, and 10,128 ureteral carcinoma cases were identified. Stage data were available for 84% of bladder cases, 83% of renal pelvis cases, and 82% of ureter cases. With the classification of early stage tumors as stage 0a, 0is, and I and late stage tumors as II, III, and IV, the percentage of early stage renal pelvis and ureter tumors increased slightly from 1993 to 2005, whereas no stage migration was seen in bladder tumors. In looking specifically at early stage tumors, a significant increase in the proportion of stage 0a and a significant decrease in the proportion of stage I tumors for each cancer site was seen between 1993 and 2005. The proportion of high grade tumors in each disease site significantly increased from 1993 to 2005. For cases diagnosed in 1993‐1996 and 1997‐2000, a significant decrease in 5‐year relative survival was observed for patients with stage I and stage II bladder cancer. The absolute change, however, was relatively small, and for bladder cases was not significantly different when adjusted for low or high grade tumors. CONCLUSIONS: When differentiating between early and late stage tumors, a slight stage migration was seen in renal pelvis and ureteral carcinomas, whereas no stage migration was seen in bladder tumors. Within early stage tumors of all sites, a stage shift was seen, most notably with the proportion of stage 0a tumors increasing and stage I tumors decreasing. The proportion of high grade tumors in all sites increased. No change in overall survival was observed, underscoring the need for new therapeutic advances. Cancer 2009. © 2009 American Cancer Society.

Expression of bone morphogenetic protein-2 and -7 in urinary bladder cancer predicts time to tumor recurrence

“…Urinary bladder cancer affected over 350,000 individuals worldwide and was the cause of 145,000 deaths in 2002 [ 14 ]. The 5-year relative survival depends on tumor stage and localization and is 81.7%, 66% and 70.6% when the tumor is located within the bladder, renal pelvis and ureter, respectively [ 15 ]. In Poland, according to a recent National Cancer Registry report (2010), urinary bladder cancer is the third and the thirteenth most frequently diagnosed male and female cancer, with the annual number of new cases being 4919 and 1377, respectively.…”

Analysis of the Distribution and Temporal Trends of Grade and Stage in Urothelial Bladder Cancer in Northern New England from 1994 to 2004

“…Recent studies in various urogenital malignancies including prostate, renal pelvis, and ureteral carcinomas have suggested a trend toward a lower tumor stage at the time of diagnosis 52068 . This study was conducted to evaluate the distribution of bladder cancer over time, given that so far only a limited number of studies have investigated stage migration in bladder cancer.…”

“…This was paralleled by a 0.74% annual decrease in the percent of patients presenting with advanced disease (p<0.001). Another study by David et al 8 examined changes in stage, grade, and survival of urothelial carcinomas of the bladder and upper urinary tract between 1993 and 2005 and observed an increase in the proportion of Ta tumors and a decrease in the percentage of T1 tumors during the study period, but no changes in the overall proportion of invasive versus non-invasive tumors. Our results of the NEBCS show a trend toward an increase in the proportion of PUNLMP, and an increase in non-invasive versus invasive tumors within the PUC-LG category, suggesting a possible shift to a more indolent phenotype.…”

“…Whether this has occurred for bladder cancer however, is uncertain. Whereas one study reports an overall decrease in the incidence of bladder cancer and a minimal decrease in advanced stage disease 7 , another study found no stage migration in bladder tumors 8 .…”

Genomic distinctions between metastatic lower and upper tract urothelial carcinoma revealed through rapid autopsy

“…Upper tract urothelial carcinoma (UTUC) is a less common entity, accounting for 5% to 10% of all urothelial tumors, and involves the ureter or renal pelvis (11). Patients with UTUC often present at an older age, with higher stage disease, which can be associated with worse survival (12)(13)(14). Standard-of-care therapy includes radical nephroureterectomy with consideration for neoadjuvant or adjuvant cisplatin-based chemotherapy in select patients.…”