|
Back to 2014 Annual Meeting Abstracts
Incidence, Clinical Characteristics, and Major Lifestyle Factors Associated with Upper Tract Urothelial Carcinoma in Two Prospectively Followed Cohorts of Men and Women.
Jed-Sian Cheng, MD/MPH1, Seth K. Bechis, MD/MS1, Mark A. Preston, MD/MPH1, Kathryn M. Wilson, ScD2, Glen W. Barrisford, MD/MS1, Alex Sanchez, MD1, Dayron Rodriguez, MD/MPH3, Adam S. Feldman, MD/MPH3, Meir Stampfer, MD/DrPH2, Eunyoung Cho, ScD2.
1Massachusetts General Hospital, Boston, MA, USA, 2Harvard School of Public Health, Boston, MA, USA, 3MGH, Boston, MA, USA.
Introduction: Upper tract urothelial carcinoma (UTUC) is a rare disease and has been characterized primarily by retrospective studies. We examined clinical characteristics among 113 men and women diagnosed with UTUC, and investigated the association of smoking, diabetes (DM), and body mass index (BMI) with risk of disease in two long term, prospectively followed cohorts.
Materials and Methods: The Nurses’ Health Study (NHS) was started in 1976 with 121,577 nurses aged 30-55, and the Health Professionals Follow-up Study (HPFS) was started in 1986 with 51,529 men aged 40-75. Medical records were reviewed for patients who reported renal and ureteral tumor diagnosis, and clinical and pathological information was collected for pathology-confirmed cases. Lifestyle factors were reported on every two years through follow-up, and Cox proportional hazards models were used to study the association of possible risk factors for UTUC.
Results: We confirmed 113 cases of UTUC, 76 in women and 37 in men. This represents 16.4% of all renal and ureteral tumors (690 cases). Incidence of UTUC in men was 2.65 per 100,000 person-years and in women was 1.70/100,000 person-years in our cohorts. Sixty-six participants had known symptoms requiring evaluation: 41 (62%) presented with gross hematuria, 54 (82%) presented with some form of hematuria, and 5 (8%) presented with flank pain. Diagnosis of UTUC was by either ureteroscopic biopsy (40%), cytology and radiology findings (33%), surgical pathology (17%), or percutaneous biopsy (10%). Of participants with known laterality, 55% presented with right sided tumors and 45% with left sided tumors. Location of the tumor was 56% in renal pelvis, 30% in the ureter and 14% in both. Multifocality was seen in 19% of cases. Median tumor size was 3.3 cm with a range of 0.2-21.4 cm. Among participants with known TNM stage, 48% were stage T1 or less, and 52% were stage T2 or greater (including 11% with N1 or M1 disease). Grade at presentation was 5% G1, 44% G2, and 51% G3. A total of 17% of UTUC patients also had bladder cancer: 42% were diagnosed after the UTUC, 32% before, and 26% concurrently. In both women and men, respectively, current smoking was associated with a significantly increased risk of UTUC compared to never having smoked (RR 5.86 [3.09-11.15]; RR 7.05, [2.30-21.65]), while BMI>25 (RR 1.29 [0.80-2.09]; RR 1.04 [0.51-2.10]) and type 2 diabetes (RR 1.61 [0.80-3.25]; RR 1.21 [0.29-5.02]) were not significantly associated with increased risk of UTUC.
Conclusions: To our knowledge, this represents the first descriptive statistics on UTUC in large, prospectively followed cohorts of men and women. Current smoking was significantly associated with risk in both men and women, while past smoking, BMI, and type 2 diabetes were not significantly associated with risk. The finding of 17.8% UTUC among all kidney and ureteral tumors is higher than traditionally reported.
Back to 2014 Annual Meeting Abstracts
|
|
