当代浸润性上尿路上皮癌患者的发病率和生存率。
Incidence and Survival Rates of Contemporary Patients with Invasive Upper Tract Urothelial Carcinoma.
机构信息
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples Federico II, Naples, Italy.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy.
出版信息
Eur Urol Oncol. 2021 Oct;4(5):792-801. doi: 10.1016/j.euo.2020.11.005. Epub 2020 Dec 5.
BACKGROUND
Contemporary incidence and mortality rates of upper tract urothelial carcinoma (UTUC) are unavailable.
OBJECTIVE
To describe contemporary UTUC incidence and mortality rates in the USA.
DESIGN, SETTING, AND PARTICIPANTS: Within the Surveillance, Epidemiology and End Results (SEER) database (2004-2016), we identified 13 075 UTUC patients. Of all, 9208 (70.4%) harbored nonmetastatic UTUC and were treated with radical nephroureterectomy versus 1174 (9.0%) who harbored metastatic UTUC.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Age-standardized incidence rates per 100 000 person years were calculated. Kaplan-Meier curves and multivariable Cox regression models addressed cancer-specific and overall mortality.
RESULTS AND LIMITATIONS
Overall UTUC age-standardized incidence rates decreased from 1.3 to 1.1 cases per 100 000 person years (average annual percentage change: -1.32%, p = 0.002). Moreover, age-standardized incidence rates decreased for TNM (average annual percentage change: -2.77%, p < 0.001) but increased for TNM stage (average annual percentage change: +2.87%, p < 0.01). In nonmetastatic UTUC treated with radical nephroureterectomy, stage, grade, age, and sex (p < 0.001) were independent predictors in multivariable Cox regression models focusing on cancer-specific mortality. In metastatic UTUC, chemotherapy administration, radical nephroureterectomy treatment, and ureteral primary were independent predictors of lower overall mortality in multivariable Cox regression models.
CONCLUSIONS
Although overall incidence of UTUC decreased, the incidence of metastatic UTUC increased over the study period. The majority of nonmetastatic UTUC harbored TNM stage. However, TNM, TNM, and TNM stages, respectively, affected 28.9%, 4.6%, and 10.0% of all incident cases. In metastatic UTUC, both chemotherapy and radical nephroureterectomy use exerted an important protective effect on overall mortality, and ureteral primaries exhibited more favorable survival.
PATIENT SUMMARY
From 2004 to 2016, the incidence of upper tract urothelial carcinoma decreased in the USA. However, more advanced stages are on the rise.
背景
目前尚无法获得上尿路尿路上皮癌（UTUC）的当代发病率和死亡率数据。
目的
描述美国 UTUC 的当代发病率和死亡率。
设计、设置和参与者：在监测、流行病学和最终结果（SEER）数据库（2004-2016 年）中，我们鉴定了 13075 例 UTUC 患者。其中，9208 例（70.4%）患者存在非转移性 UTUC，并接受根治性肾输尿管切除术治疗，1174 例（9.0%）患者存在转移性 UTUC。
结局测量和统计学分析
计算每 100000 人年的年龄标准化发病率。通过 Kaplan-Meier 曲线和多变量 Cox 回归模型分析癌症特异性和总死亡率。
结果和局限性
总体 UTUC 的年龄标准化发病率从 1.3 降至 1.1 例/100000 人年（平均年变化百分比：-1.32%，p=0.002）。此外，TNM（平均年变化百分比：-2.77%，p<0.001）的年龄标准化发病率降低，但 TNM 分期（平均年变化百分比：+2.87%，p<0.01）的发病率增加。在接受根治性肾输尿管切除术治疗的非转移性 UTUC 中，在多变量 Cox 回归模型中，分期、分级、年龄和性别（p<0.001）是癌症特异性死亡率的独立预测因素。在转移性 UTUC 中，化疗、根治性肾输尿管切除术治疗和输尿管原发性分别是多变量 Cox 回归模型中总死亡率降低的独立预测因素。
结论
尽管 UTUC 的总体发病率有所下降，但研究期间转移性 UTUC 的发病率却有所增加。大多数非转移性 UTUC 存在 TNM 分期。然而，TNM、TNM 和 TNM 分期分别影响了所有新发病例的 28.9%、4.6%和 10.0%。在转移性 UTUC 中，化疗和根治性肾输尿管切除术的应用对总死亡率均有重要的保护作用，而输尿管原发性表现出更好的生存情况。
患者总结
2004 年至 2016 年期间，美国上尿路尿路上皮癌的发病率有所下降。然而，更晚期的肿瘤分期呈上升趋势。
Zotero 插件