Department of Urology, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan.
Department of Urology, National Cheng-Kung University Hospital, Tainan, Taiwan.
BMC Cancer. 2021 Jan 19;21(1):80. doi: 10.1186/s12885-021-07799-4.
A high incidence of upper urinary tract urothelial carcinoma has been reported in the southwestern area of Taiwan, where arsenic water contamination was considered the main cause. However, there is no definite proof to show a correlation between arsenic water contamination and upper urinary tract urothelial carcinoma. To investigate the clinical and epidemiological features of patients with upper urinary tract urothelial carcinoma between arsenic water endemic and non-endemic areas, we analyzed patients in terms of characteristics, stratified overall survival, disease-free survival, and cancer-specific survival.
The records of a total of 1194 patients diagnosed with upper urinary tract urothelial carcinoma were retrospectively reviewed. Clinical data and current medical status were collected from the medical records. Statistical analyses were performed to determine the clinical variables and stratified survival curves between endemic and non-endemic groups.
Female predominance was revealed in both endemic and non-endemic groups (male:female ratio = 1:1.2-1.4). No statistical differences were found in histological types, staging, and tumor size between the two groups. Nonetheless, patients with characteristics of aging and having end-stage renal disease were outnumbered in the non-endemic group, while a higher prevalence of previous bladder tumors and more ureteral tumors were found in the endemic group. Adjusted stratified cumulative survival curves suggested a poorer prognosis in endemic patients, especially in disease-free survival of early stage disease.
A higher mortality rate with more previous bladder cancer history and ureteral tumors was seen in patients with upper urinary tract urothelial carcinoma residing in the arsenic water contamination area. This may be attributed to the long-term carcinogenic effect of arsenic underground water.
台湾西南部地区曾报道有较高的上尿路尿路上皮癌发病率，而砷水污染被认为是主要原因。然而，没有明确的证据表明砷水污染与上尿路尿路上皮癌之间存在相关性。为了研究砷水污染地区和非污染地区上尿路尿路上皮癌患者的临床和流行病学特征，我们对患者的特征进行了分析，并对总生存、无病生存和癌症特异性生存进行了分层分析。
回顾性分析了共 1194 例上尿路尿路上皮癌患者的病历。从病历中收集了临床数据和当前的医疗状况。进行了统计学分析，以确定流行区和非流行区之间的临床变量和分层生存曲线。
在流行区和非流行区均以女性为主（男：女比例为 1:1.2-1.4）。两组在组织学类型、分期和肿瘤大小方面无统计学差异。然而，非流行区患者的特征为年龄较大和终末期肾病，而流行区患者则更多表现为既往膀胱癌病史和更多的输尿管肿瘤。调整后的分层累积生存曲线表明，流行区患者的预后较差，尤其是早期疾病的无病生存率。
在砷水污染地区居住的上尿路尿路上皮癌患者中，死亡率更高，既往膀胱癌病史和输尿管肿瘤更多。这可能归因于地下水砷的长期致癌作用。
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