Prognostic value of Balkan endemic nephropathy and gender on upper tract urothelial carcinoma outcomes after radical nephroureterectomy: A cohort study

• Published in: Urologic oncology 2021-11, Vol.39 (11), p.786.e9-786.e16
• Main Authors: Milojevic, Bogomir, Dzamic, Zoran, Grozdic Milojevic, Isidora, Bumbasirevic, Uros, Santric, Veljko, Kajmakovic, Boris, Janicic, Aleksandar, Durutovic, Otas, Dragicevic, Dejan, Bojanic, Nebojsa, Radisavcevic, Djordje, Sipetic Grujicic, Sandra
• Format: Article
• Language: English
• Subjects: Aged; Balkan endemic nephropathy; Balkan Nephropathy - etiology; Balkan Nephropathy - physiopathology; Cohort Studies; Female; Gender; Humans; Male; Nephroureterectomy - adverse effects; Nephroureterectomy - methods; Prognosis; Radical nephroureterectomy; Recurrence; Upper tract urothelial carcinoma; Urinary Bladder Neoplasms - complications; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2021.03.016

•Residence in a Balkan endemic nephropathy area is an independent predictor of bladder cancer recurrence.•The influence of environmental factor in the endemic areas is weakened.•More than 2/3 of the patients with upper tract urothelial tumors are from the non-endemic areas.•Gender is unable to predict outcomes in patients treated with radical nephroureterectomy. To identify the prognostic impact of residence in a BEN-endemic area and gender on upper tract urothelial carcinoma (UTUC) outcomes in Serbian patients treated with radical nephroureterectomy (RNU). The study included 334 consecutive patients with UTUC. Patients with permanent residence in Balkan endemic nephropathy (BEN) or non-endemic areas from their birth to the end of follow-up were included in the analysis. Cox regression analyses were used to address recurrence-free (RFS) and cancer-specific survival (CSS) estimates. Female patients were more likely to have preoperative pyuria (P = 0.01), tumor multifocality was significantly associated with the female gender (P = 0.003). Gender was not associated with pathologic stage and grade, lymph node metastasis, lymphovascular invasion, adjuvant chemotherapy, bladder cancer history, tumor size, distribution of tumor location, preoperative anemia and demographic characteristics. A total of 107 cases recurred, with a median time to bladder recurrence of 24.5 months. History of bladder tumor (HR, 1.98; P = 0.005), tumor multifocality (HR, 3.80; P < 0.001) and residence in a BEN-endemic area (HR, 1.81; P = 0.01) were independently associated with bladder cancer recurrence. The 5-year bladder cancer RFS for the patients from areas of BEN was 77.8 % and for the patients from non-BEN areas was 64.7 %. The 5-year CSS for the men was 66.2% when compared to 66.6% for the women (P = 0.55). Residence in a BEN-endemic area represents an independent predictor of bladder cancer recurrence in patients who underwent RNU. Gender cannot be used to predict outcomes in a single-centre series of consecutive patients who were treated with RNU for UTUC.