Rising incidence rates and unaltered survival for primary upper urinary tract urothelial carcinoma: a Dutch population-based study from 1993 to 2017.

To assess trends in incidence, disease management and survival of upper urinary tract urothelial carcinoma (UTUC) in the Netherlands.

Patients diagnosed with primary UTUC in the Netherlands between 1993 and 2017 were identified through the population-based Netherlands Cancer Registry (NCR).

Patient- and tumor characteristics as well as information on treatment and vital status were retrieved from the NCR. Age-standardized incidence rates were calculated stratified by age, gender, calendar-period and disease stage. Relative survival served as approximation for cancer-specific survival.

We identified 13,314 patients with primary UTUC. The age-standardized incidence rate increased from 2.0 in 1993 to 3.2 per 100,000 person-years in 2017, without change in gender distribution. The increase in incidence holds for all disease stages except organ-confined (T1-T2) disease. The most prominent increase was in superficial (Tis/Ta) and metastatic (M+) UTUC; from 0.6 to 1.2 and 0.1 to 0.4 per 100,000 person-years, respectively. The 5-year relative survival did not change over time; 57.0% (95% Confidence Interval: 55.9-58.1). Applied treatments were largely the same over the study period, although fewer radical nephroureterectomies and more kidney-sparing surgeries were performed in the most recent years. The use of perioperative intravesical chemotherapy had modestly increased.

Between 1993 and 2017, the age-standardized incidence of primary UTUC in the Netherlands has increased by more than 50%, but the relative survival of UTUC patients remained unchanged. Preventive measures against exposure to risk factors, early detection of disease, and more efficacious treatment modalities are needed to improve outcomes of patients with UTUC.

BJU international. 2021 Mar 10 [Epub ahead of print]

Thomas van Doeveren, Marianne van der Mark, Pim J van Leeuwen, Joost L Boormans, Katja K H Aben

Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands., Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands., Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.

Read an Expert Commentary by Bishoy Faltas, MD