A multi-institutional comparison of clinicopathologic characteristics and oncologic outcomes of upper tract urothelial carcinoma in China and the United States

To evaluate differences in clinicopathologic characteristics and oncologic outcomes between upper-tract urothelial carcinoma (UTUC) patients in China and the United States (U.S.).

Clinicopathologic and oncologic outcomes data of UTUC patients treated surgically at tertiary care medical facilities in the U. S. or China from 1998-2015 were retrospectively compiled. Baseline demographics, comorbidities, and pathologic features were evaluated. Oncologic endpoints including intravesical recurrence and cancer-specific survival (CSS) were obtained following exclusion of patients who received systemic chemotherapy. Multivariable Cox regression was performed to determine predictors of adverse oncologic outcomes for each country.

775 UTUC patients were identified (451 China, 324 U.S.) with a median follow-up of 42 months. U.S. patients were more frequently male (65% vs. 44%, p<0.001), smokers (79% vs. 18%, p<0.001), had worse mean ASA score (2.7 vs. 2.2, p<0.001), and had prior bladder cancer (41% vs. 4%, p<0.001). Chinese patients more often had pre-operative hydronephrosis (56% vs. 40%, p<0.001), high-grade pathology (98% vs. 77%, p<0.001), muscle-invasion (64% vs. 38%, p<0.001), and nodal metastases (26% vs. 6%, p<0.001). U.S. patients had worse overall survival (OS) on Kaplan-Meier analysis (p=0.049), while country of origin did not predict local relapse or CSS.

Patient and disease characteristics of UTUC differ between Chinese and U.S. cohorts. Chinese patients appear relatively healthier at presentation but more often exhibit adverse pathologic features. While evaluation and management patterns may account for these variations, the pathologic findings may reflect differential underlying pathogenesis of disease, and additional study is warranted to further characterize these differences.

The Journal of urology. 2016 Jan 22 [Epub ahead of print]

Nirmish Singla, Dong Fang, Xiaohong Su, Zhengqing Bao, Zhenpeng Cao, Syed M Jafri, Gengyan Xiong, Lei Zhang, Ryan Hutchinson, Arthur Sagalowsky, Yair Lotan, Xuesong Li, Liqun Zhou, Jay D Raman, Vitaly Margulis

Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China., Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: .