Urinary tuberculosis is associated with the development of urothelial carcinoma but not renal cell carcinoma: a nationwide cohort study in Taiwan

Abstract

Background:Obstructive uropathy and chronic urinary tract infection increase the risk of urinary tract cancer. Urinary tuberculosis (UTB) can cause chronic urinary tract inflammation, lead to obstructive uropathy, and potentially contribute to the development of urinary tract cancer. However, the association between UTB and urinary tract cancer has not been studied.Methods:This study enrolled 135 142 tuberculosis (TB) cases (male, 69%) from a nationwide health insurance research database in Taiwan and investigated the risk factors for urinary tract cancer, with emphasis on a history of UTB. The incidence of urinary tract cancer in the general population without TB was also calculated for comparison.Results:The TB patients had a mean age of 57.5±19.5 years. Of the 1287 UTB and 133 855 non-UTB patients, 15 (1.2%) and 396 (0.3%) developed urothelial carcinoma, respectively (P<0.001); and 2 (0.2%) and 96 (0.1%) developed renal cell carcinoma, respectively (P=0.240). Cox regression analysis revealed that age, male sex, end-stage renal disease, obstructive uropathy, arsenic intoxication, organ transplantation, and UTB (hazard ratio: 3.38 (2.01–5.69)) were independent risk factors for urothelial carcinoma. The hazard ratio of UTB was higher among female patients (5.26 (2.12–13.06)) than that among male patients (2.96 (1.57–5.60)).Conclusion:Urinary tuberculosis had a strong association with urothelial carcinoma, but not with renal cell carcinoma. In TB endemic areas, the urinary tract of TB patients should be scrutinised. It is also imperative that these patients be followed-up carefully in the post-treatment period, and urinalysis, ultrasonography or endoscopy should be an integral part of the follow-up.

Preoperative pyuria predicts advanced pathologic tumor stage and worse survival in patients with urothelial carcinoma of the upper urinary tract treated by radical nephroureterectomy

“…In addition, a work by Obata et al [15] showed that preoperative C-reactive protein could count as a biomarker of survival in patients with localized UTUC following RNU. As for urinary inflammation, recently there also emerged evidence supporting that chronic urinary tract infection, caused by urinary tuberculosis, could increase the risk of UTUC [16]. In response to these data, our result seems to further suggest a prognostic value of urine inflammation in UTUC.…”

Higher risk of urothelial carcinoma in the upper urinary tract than in the urinary bladder in hemodialysis patients

“…Some studies were reported that there are many possibilities such as urinary TB infection, gene, or carcinogenicity that may explain the increased ratio of female patients in contrast to the male predominance. 11,12 Furthermore, there are many studies in Chinese population show that unusual increase in the ratio of female-to-male incidence in UTUC which accounts for approximately 30-40% of all cases of UC in Taiwan, which is different from other countries. 13,14 The incidence rate of ESRD in Taiwan increased from 375 per 1,000,000 in 2004 to 404 per 1,000,000 in 2005, 15 and the prevalence of ESRD in Taiwan is the highest worldwide.…”

Nine- to Twelve-Month Anti-Tuberculosis Treatment Is Associated with a Lower Recurrence Rate than 6–9-Month Treatment in Human Immunodeficiency Virus-Infected Patients: A Retrospective Population-Based Cohort Study in Taiwan

“…Underlying comorbidities were recorded if they were present before the diagnosis of pulmonary TB, according to a previous publication [ 12 ]. The low-income group was defined as having an annual household income <4500 US dollars according to enrollment files [ 13 ].…”