A Multi-Institutional Comparison of Clinicopathological Characteristics and Oncologic Outcomes of Upper Tract Urothelial Carcinoma in China and the United States

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 Raman, Vitaly Margulis

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Abstract

Purpose We evaluated differences in clinicopathological characteristics and oncologic outcomes between patients with upper tract urothelial carcinoma in mainland China and the United States. Materials and Methods We retrospectively compiled clinicopathological and oncologic outcomes data on patients with upper tract urothelial carcinoma treated surgically at tertiary care medical facilities in the United States or China from 1998 to 2015. Baseline demographics, comorbidities and pathological features were evaluated. Oncologic end points, including intravesical recurrence and cancer specific survival, were obtained after excluding patients who received systemic chemotherapy. Multivariable Cox regression was performed to determine predictors of adverse oncologic outcomes for each country. Results A total of 775 patients with upper tract urothelial carcinoma were identified, including 451 in China and 324 in the United States. Median followup was 42 months. American patients were more frequently male (65% vs 44%) and smokers (79% vs 18%), and had a worse mean ASA® (American Society of Anesthesiologists®) score (2.7 vs 2.2) and prior bladder cancer (41% vs 4%, all p <0.001). Chinese patients more often had preoperative hydronephrosis (56% vs 40%), high grade pathology (98% vs 77%), muscle invasion (64% vs 38%) and nodal metastases (26% vs 6%, all p <0.001). American patients had worse overall survival on Kaplan-Meier analysis (p = 0.049). However, country of origin did not predict local relapse or cancer specific survival. Conclusions Patient and disease characteristics of upper tract urothelial carcinoma differed between the Chinese and American cohorts. Chinese patients appeared relatively healthier at presentation but more often exhibited adverse pathological features. While evaluation and management patterns may account for these variations, the pathological findings may reflect a differential underlying pathogenesis of disease. Additional study is warranted to further characterize these differences.

Original languageEnglish (US)
Pages (from-to)1208-1213
Number of pages6
JournalJournal of Urology
Volume197
Issue number5
DOIs
StatePublished - May 1 2017

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China
Carcinoma
Survival
Recurrence
Asian Americans
Hydronephrosis
Kaplan-Meier Estimate
Tertiary Healthcare
Urinary Bladder Neoplasms
Comorbidity
Neoplasms
Demography
Pathology
Neoplasm Metastasis
Drug Therapy
Muscles

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Singla, Nirmish ; Fang, Dong ; Su, Xiaohong ; Bao, Zhengqing ; Cao, Zhenpeng ; Jafri, Syed M. ; Xiong, Gengyan ; Zhang, Lei ; Hutchinson, Ryan ; Sagalowsky, Arthur ; Lotan, Yair ; Li, Xuesong ; Zhou, Liqun ; Raman, Jay ; Margulis, Vitaly. / A Multi-Institutional Comparison of Clinicopathological Characteristics and Oncologic Outcomes of Upper Tract Urothelial Carcinoma in China and the United States. In: Journal of Urology. 2017 ; Vol. 197, No. 5. pp. 1208-1213.
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title = "A Multi-Institutional Comparison of Clinicopathological Characteristics and Oncologic Outcomes of Upper Tract Urothelial Carcinoma in China and the United States",
abstract = "Purpose We evaluated differences in clinicopathological characteristics and oncologic outcomes between patients with upper tract urothelial carcinoma in mainland China and the United States. Materials and Methods We retrospectively compiled clinicopathological and oncologic outcomes data on patients with upper tract urothelial carcinoma treated surgically at tertiary care medical facilities in the United States or China from 1998 to 2015. Baseline demographics, comorbidities and pathological features were evaluated. Oncologic end points, including intravesical recurrence and cancer specific survival, were obtained after excluding patients who received systemic chemotherapy. Multivariable Cox regression was performed to determine predictors of adverse oncologic outcomes for each country. Results A total of 775 patients with upper tract urothelial carcinoma were identified, including 451 in China and 324 in the United States. Median followup was 42 months. American patients were more frequently male (65{\%} vs 44{\%}) and smokers (79{\%} vs 18{\%}), and had a worse mean ASA{\circledR} (American Society of Anesthesiologists{\circledR}) score (2.7 vs 2.2) and prior bladder cancer (41{\%} vs 4{\%}, all p <0.001). Chinese patients more often had preoperative hydronephrosis (56{\%} vs 40{\%}), high grade pathology (98{\%} vs 77{\%}), muscle invasion (64{\%} vs 38{\%}) and nodal metastases (26{\%} vs 6{\%}, all p <0.001). American patients had worse overall survival on Kaplan-Meier analysis (p = 0.049). However, country of origin did not predict local relapse or cancer specific survival. Conclusions Patient and disease characteristics of upper tract urothelial carcinoma differed between the Chinese and American cohorts. Chinese patients appeared relatively healthier at presentation but more often exhibited adverse pathological features. While evaluation and management patterns may account for these variations, the pathological findings may reflect a differential underlying pathogenesis of disease. Additional study is warranted to further characterize these differences.",
author = "Nirmish Singla and Dong Fang and Xiaohong Su and Zhengqing Bao and Zhenpeng Cao and Jafri, {Syed M.} and Gengyan Xiong and Lei Zhang and Ryan Hutchinson and Arthur Sagalowsky and Yair Lotan and Xuesong Li and Liqun Zhou and Jay Raman and Vitaly Margulis",
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Singla, N, Fang, D, Su, X, Bao, Z, Cao, Z, Jafri, SM, Xiong, G, Zhang, L, Hutchinson, R, Sagalowsky, A, Lotan, Y, Li, X, Zhou, L, Raman, J & Margulis, V 2017, 'A Multi-Institutional Comparison of Clinicopathological Characteristics and Oncologic Outcomes of Upper Tract Urothelial Carcinoma in China and the United States', Journal of Urology, vol. 197, no. 5, pp. 1208-1213. https://doi.org/10.1016/j.juro.2016.11.094

A Multi-Institutional Comparison of Clinicopathological Characteristics and Oncologic Outcomes of Upper Tract Urothelial Carcinoma in China and the United States. / Singla, Nirmish; Fang, Dong; Su, Xiaohong; Bao, Zhengqing; Cao, Zhenpeng; Jafri, Syed M.; Xiong, Gengyan; Zhang, Lei; Hutchinson, Ryan; Sagalowsky, Arthur; Lotan, Yair; Li, Xuesong; Zhou, Liqun; Raman, Jay; Margulis, Vitaly.

In: Journal of Urology, Vol. 197, No. 5, 01.05.2017, p. 1208-1213.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A Multi-Institutional Comparison of Clinicopathological Characteristics and Oncologic Outcomes of Upper Tract Urothelial Carcinoma in China and the United States

AU - Singla, Nirmish

AU - Fang, Dong

AU - Su, Xiaohong

AU - Bao, Zhengqing

AU - Cao, Zhenpeng

AU - Jafri, Syed M.

AU - Xiong, Gengyan

AU - Zhang, Lei

AU - Hutchinson, Ryan

AU - Sagalowsky, Arthur

AU - Lotan, Yair

AU - Li, Xuesong

AU - Zhou, Liqun

AU - Raman, Jay

AU - Margulis, Vitaly

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Purpose We evaluated differences in clinicopathological characteristics and oncologic outcomes between patients with upper tract urothelial carcinoma in mainland China and the United States. Materials and Methods We retrospectively compiled clinicopathological and oncologic outcomes data on patients with upper tract urothelial carcinoma treated surgically at tertiary care medical facilities in the United States or China from 1998 to 2015. Baseline demographics, comorbidities and pathological features were evaluated. Oncologic end points, including intravesical recurrence and cancer specific survival, were obtained after excluding patients who received systemic chemotherapy. Multivariable Cox regression was performed to determine predictors of adverse oncologic outcomes for each country. Results A total of 775 patients with upper tract urothelial carcinoma were identified, including 451 in China and 324 in the United States. Median followup was 42 months. American patients were more frequently male (65% vs 44%) and smokers (79% vs 18%), and had a worse mean ASA® (American Society of Anesthesiologists®) score (2.7 vs 2.2) and prior bladder cancer (41% vs 4%, all p <0.001). Chinese patients more often had preoperative hydronephrosis (56% vs 40%), high grade pathology (98% vs 77%), muscle invasion (64% vs 38%) and nodal metastases (26% vs 6%, all p <0.001). American patients had worse overall survival on Kaplan-Meier analysis (p = 0.049). However, country of origin did not predict local relapse or cancer specific survival. Conclusions Patient and disease characteristics of upper tract urothelial carcinoma differed between the Chinese and American cohorts. Chinese patients appeared relatively healthier at presentation but more often exhibited adverse pathological features. While evaluation and management patterns may account for these variations, the pathological findings may reflect a differential underlying pathogenesis of disease. Additional study is warranted to further characterize these differences.

AB - Purpose We evaluated differences in clinicopathological characteristics and oncologic outcomes between patients with upper tract urothelial carcinoma in mainland China and the United States. Materials and Methods We retrospectively compiled clinicopathological and oncologic outcomes data on patients with upper tract urothelial carcinoma treated surgically at tertiary care medical facilities in the United States or China from 1998 to 2015. Baseline demographics, comorbidities and pathological features were evaluated. Oncologic end points, including intravesical recurrence and cancer specific survival, were obtained after excluding patients who received systemic chemotherapy. Multivariable Cox regression was performed to determine predictors of adverse oncologic outcomes for each country. Results A total of 775 patients with upper tract urothelial carcinoma were identified, including 451 in China and 324 in the United States. Median followup was 42 months. American patients were more frequently male (65% vs 44%) and smokers (79% vs 18%), and had a worse mean ASA® (American Society of Anesthesiologists®) score (2.7 vs 2.2) and prior bladder cancer (41% vs 4%, all p <0.001). Chinese patients more often had preoperative hydronephrosis (56% vs 40%), high grade pathology (98% vs 77%), muscle invasion (64% vs 38%) and nodal metastases (26% vs 6%, all p <0.001). American patients had worse overall survival on Kaplan-Meier analysis (p = 0.049). However, country of origin did not predict local relapse or cancer specific survival. Conclusions Patient and disease characteristics of upper tract urothelial carcinoma differed between the Chinese and American cohorts. Chinese patients appeared relatively healthier at presentation but more often exhibited adverse pathological features. While evaluation and management patterns may account for these variations, the pathological findings may reflect a differential underlying pathogenesis of disease. Additional study is warranted to further characterize these differences.

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