Characteristics and regional difference of Chinese upper tract urothelial carcinoma patients: a multi-center study by CUDA-UTUC Collaborative Group

Objective To illustrate the clinical and pathological features of Chinese upper tract urothelial carcinoma (UTUC) patients and to investigate the regional difference and the possible prognostic factors. Methods A retrospective study was performed on 2 628 patients from 9 centers of three different regions (Beijing: 2 centers with 1 022 cases, Shanghai: 1 center with 814 cases, Sichuan: 6 center with 792 cases). The median age was 68 (range 20 to 93) and the mean age was 66.3. There were 1 447 male patients (55.1%) and 1 181 female patients (44.9%). The clinical information, pathological outcomes and prognosis were collected and analyzed based on South (Shanghai and Sichuan) and North (Beijing) region. Results The distribution of Ta+ T1, T2, T3 and T4 was 914(34.8%), 715(27.2%), 857(32.6%) and 142(5.4%). Patients from North were more likely to be female (55.9% vs. 38.0%, P<0.001) and suffer from ureteral tumors (43.4% vs. 35.9%, P<0.001); while in patients from South higher tumor stage(T3 or T4, 42.5% vs. 31.0%, P<0.001 ), high grade(72.0% vs. 34.0%, P<0.001) and larger tumor size [(3.73±2.17) cm vs. (3.36±2.02) cm, P<0.001] were more prevalent. Subgroup indicated that female patients in North had obviously lower tumor stage (T3 or T4, 27.2% vs. 35.9%, P=0.014), while relatively higher tumor stage were noticed in female patients in South (T3 or T4, 48.2% vs. 38.9%, P=0.004). The median follow-up was 41(1-206) months, and 963 patients (36.6%) died including 815 (31.0%) died from cancer. In North female patients had better 5-year overall survival (75.5% vs. 62.2%, P <0.001) and cancer-specific survival (78.3% vs. 65.0%, P<0.001), but in South gender had no impact on overall survival (58.5% vs. 60.1%, P=0.927) or cancer-specific survival (62.0% vs. 65.8%, P=0.345). Conclusions This study demonstrated that in Chinese patients with UTUC, those from North were featured for lower tumor stage and grade, higher proportion of females and females had better survival. High age, high tumor stage and grade, large tumor diameter, and the presence of lymph node metastasis or lymphovascular invasion were risk factors for poor prognosis in Chinese UTUC patients. Key words: Upper tract urothelial carcinoma (UTUC); Gender; Prognosis; Multi-center study