Abstract
The goal of this study is exploring the disparity of incidence, mortality and survival outcome among transitional cell carcinomas (TCCs) in the 4 parts of urinary system. This study comprehensively evaluates these disparities using the Surveillance, Epidemiology, and End Results (SEER) (2000–2018) database. According to the SEER database, the urinary tract is divided into 4 parts: urinary bladder, renal pelvis, ureter, and urethra. The joinpoint regression was used to analyze the secular trend of incidence and incidence-based mortality (IBM). The Kaplan–Meier method with the log-rank test is performed to evaluate survival outcomes. The bladder TCC has the highest age-adjusted incidence and mortality rate compared with TCC in other 3 locations. A slight decrease in incidence is shown in the both bladder and urethra TCCs during 2000–2018. The age-adjusted mortality rate similarly presents an initial increase among 4 locations TCCs at the beginning of study period. The survival curves demonstrate that patients with bladder TCCs have better overall survival (OS) and cancer-specific survival (CSS), whereas those with renal pelvis TCCs have the worse OS and CSS. In addition, patients with bladder TCC have the highest 1-year, 3-year, 5-year relative survival rate, and those with renal pelvis TCC have the lowest. These disparities are especially essential when we explore tumor characteristics and treatment, extrapolated from the literature on bladder TCC for upper tract urothelial carcinoma (UTUC). Notably, patients with bladder TCC especially for localized stage have better survival outcomes than those with UTUC.
Keywords: bladder, epidemiology, prognosis, renal pelvis, transitional cell carcinoma, ureter, urethra
1. Introduction
Transitional cell carcinoma (TCC), formerly known as Urothelial Carcinoma (UC), is the fourth most common tumor worldwide.[1] Meanwhile, it is also the common form of histology in the urinary tract, which can be observed in the lower (bladder and urethra) or the upper (renal pelvis and ureter) urinary tract.[2] The European Association of Urology Guidelines revealed that approximately 90% of bladder and renal pelvis cancer patients presented with transitional cell carcinoma. This data is more than 90% in the ureter.[2–5]
While the urinary tract carcinoma presented the same histology of TCC, differences such as tumor characteristics, epidemiology, treatment between TCC in different locations of the urinary tract and ignoring the significant differences may hinder us from optimizing therapy in patients with TCC.[6,7] Due to the unusual nature of upper tract urothelial carcinoma (UTUC), which accounts for only 5%–10% of all TCC, lots of hypotheses of the biology of UTUC and clinical treatment decisions are extrapolated from TCC in the bladder.[7] Moreover, when most guidelines develop a treatment for renal pelvis and ureter carcinoma, they usually treat these 2 carcinomas as a whole, owing to insufficient studies on their variations.[4,8]
Up to our knowledge, there have been no previous studies detailly exploring the epidemiology of TCC in the urinary system. Therefore, we searched the Surveillance, Epidemiology, and End Results (SEER) database, which divided the urinary tract into 4 parts: urinary bladder, renal pelvis, ureter, and urethra. We explored the dissimilarities involving the trends in incidence and mortality rate, cancer characteristics, treatment and survival outcomes among TCCs in 4 parts of the urinary tract. We believe this novel information can help the urologist and the patient better understand TCC in the urinary system and formulate more precise treatment plans.
2. Materials and methods
2.1. Data source and population selection
All data in this study were from the Surveillance, Epidemiology, and End Results (SEER) database, which included detailed patient demographic and cancer information of the US population. Incident cases were obtained from the case listing of Incidence - SEER Research Plus Data, 18 Registries, Nov 2020 Sub (2000–2018) - Linked To County Attributes, which collected data on cancer incidence and mortality involving approximately 26.4% of the U.S. population. Incidence-Based mortality cases were obtained from the case listing of Incidence-Based Mortality - SEER Research Data, 18 Registries, Nov 2020 Sub (2000–2018) - Linked To County Attributes.
Firstly, patients diagnosed with transitional cell carcinoma, no other specific (TCC NOS code 8120/3) were identified based on International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3).[9] The pathological information was obtained from the variable of ICD-O-3 Hist/behave. Subsequently, according to the site recode ICD-O-3 list and CS Schema - AJCC 6th Edition, 4 sites in the urinary system, including urinary bladder, renal pelvis, ureter, and urethra, were included in our study. In addition, patients with age < 15, unknown survival months, or unknown survival status were excluded from our study.
2.2. Description of variables
The variables from the SEER database included 4 parts: the demographic variables (age at diagnosis, sex, race, marital status, median household income) cancer characteristics (tumor grade, SEER summary stage) treatment information (radiotherapy, chemotherapy, and surgery recode) survival information (survival months, cancer-specific survival (CSS) and overall survival (OS). Detailed subgroup information was recorded in Table 1.
Table 1.
Demographics of patients with transitional cell carcinoma in different parts of urinary system.
| Characteristic | No. of patients (%) | |||||
|---|---|---|---|---|---|---|
| All patients | Urinary Bladder | Renal Pelvis | Ureter | Urethra | P value | |
| Total no. | 94,187 | 79419 (84.32%) | 8298 (8.81%) | 4138 (4.39%) | 2332 (2.48%) | |
| Age: Mean ± SD | 72.35 ± 10.69 | 72.21 ± 10.74 | 73.10 ± 10.49 | 73.19 ± 9.88 | 72.98 ± 10.99 | <.001 |
| Median age (25th–75th percentile) |
72 (67.5–82) | 72 (67.5–82) | 77.5 (67.5–82) | 77.5 (67.5–82) | 77.5 (67.5–82) | <.001 |
| Age | <.001 | |||||
| <40 | 465 (0.5%) | 401 (0.5%) | 36 (0.4%) | 13 (0.3%) | 15 (0.6%) | |
| 40–49 | 2462 (2.6%) | 2131 (2.7%) | 204 (2.5%) | 73 (1.8%) | 54 (2.3%) | |
| 50–59 | 9856 (10.5%) | 8486 (10.7%) | 780 (9.4%) | 342 (8.3%) | 248 (10.6%) | |
| 60–69 | 21661 (23.0%) | 18525 (23.3%) | 1714 (20.7%) | 942 (22.8%) | 480 (20.6%) | |
| 70–79 | 30122 (32.0%) | 25222 (31.8%) | 2749 (33.1%) | 1455 (35.2%) | 696 (29.8%) | |
| ≥80 | 29621 (31.4%) | 24654 (31.0%) | 2815 (33.9%) | 1313 (31.7%) | 839 (36.0%) | |
| Sex | <.001 | |||||
| Female | 25364 (26.9%) | 19602 (24.7%) | 3583 (43.2%) | 1590 (38.4%) | 589 (25.3%) | |
| Male | 68823 (73.1%) | 59817 (75.3%) | 4715 (56.8%) | 2548 (61.6%) | 1743 (74.7%) | |
| Race | <.001 | |||||
| Hispanic | 5917 (6.3%) | 4839 (6.1%) | 677 (8.2%) | 245 (5.9%) | 156 (6.7%) | |
| White | 77034 (81.8%) | 65323 (82.3%) | 6584 (79.3%) | 3366 (81.3%) | 1761 (75.5%) | |
| Black | 6184 (6.6%) | 5329 (6.7%) | 460 (5.5%) | 177 (4.3%) | 218 (9.3%) | |
| American Indian/Alaskan Asian/Pacific Islander |
4579 (4.9%) | 3528 (4.4%) | 564 (6.8%) | 349 (8.4%) | 138 (5.9%) | |
| Unknown | 473 (0.5%) | 400 (0.5%) | 13 (0.2%) | 1 (<0.001%) | 59 (2.5%) | |
| Marital status | <.001 | |||||
| Married | 53436 (56.7%) | 45165 (56.9%) | 4614 (55.6%) | 2482 (60.0%) | 1175 (50.4%) | |
| SDW | 24748 (26.3%) | 20555 (25.9%) | 2543 (30.6%) | 1147 (27.7%) | 503 (21.6%) | |
| Single | 9541 (10.1%) | 8237 (10.4%) | 764 (9.2%) | 315 (7.6%) | 225 (9.6%) | |
| Unknown | 6462 (6.9%) | 5462 (6.9%) | 377 (4.5%) | 194 (4.7%) | 429 (18.4%) | |
| Median household income | <.001 | |||||
| < $35,000 | 1380 (1.5%) | 1166 (1.5%) | 126 (1.5%) | 60 (1.4%) | 28 (1.2%) | |
| $35,000- $54,999 | 20981 (22.3%) | 17717 (22.3%) | 1804 (21.7%) | 929 (22.5%) | 531 (22.8%) | |
| $55,000- $74,999 | 43347 (46.0%) | 36699 (46.2%) | 3736 (45.0%) | 1825 (44.1%) | 1087 (46.6%) | |
| >$75,000 | 28479 (30.2%) | 23837 (30.0%) | 2632 (31.7%) | 1324 (32.0%) | 686 (29.4%) | |
| Grade | <.001 | |||||
| Grade I | 3140 (3.3%) | 2887 (3.6%) | 134 (1.6%) | 90 (2.2%) | 29 (1.2%) | |
| Grade II | 7656 (8.1%) | 6666 (8.4%) | 566 (6.8%) | 316 (7.6%) | 108 (4.6%) | |
| Grade III | 24515 (26.0%) | 20679 (26.0%) | 2286 (27.5%) | 1156 (27.9%) | 394 (16.9%) | |
| Grade IV | 39742 (42.2%) | 34254 (43.1%) | 2956 (35.6%) | 1742 (42.1%) | 790 (33.9%) | |
| Unknown | 19134 (20.3%) | 14933 (18.8%) | 2356 (28.4%) | 834 (20.2%) | 1011 (43.4%) | |
| SEER Summary stage | <.001 | |||||
| In situ | 15060 (16.0%) | 15060 (19.0%) | NA | NA | NA | |
| Localized | 42664 (45.3%) | 40835 (51.4%) | 1829 (22.0%) | NA | NA | |
| Regional | 16360 (17.4%) | 12856 (16.2%) | 3504 (42.2%) | NA | NA | |
| Distant | 20103 (21.3%) | 10668 (13.4%) | 2965 (35.7%) | NA | NA | |
| Radiotherapy | <.001 | |||||
| No | 86330 (91.7%) | 72346 (91.1%) | 7951 (95.8%) | 3851 (93.1%) | 2182 (93.6%) | |
| Yes | 7857 (8.3%) | 7073 (8.9%) | 347 (4.2%) | 287 (6.9%) | 150 (6.4%) | |
| Chemotherapy | ||||||
| No | 70595 (75.0%) | 59471 (74.9%) | 6165 (74.3%) | 3099 (74.9%) | 1860 (79.8%) | |
| Yes | 23592 (25.0%) | 19948 (25.1%) | 2133 (25.7%) | 1039 (25.1%) | 472 (20.2%) | |
| Surgery recode | <.001 | |||||
| No | 13889 (14.7%) | 9033 (11.4%) | 2640 (31.8%) | 974 (23.5%) | 1242 (53.3%) | |
| Yes | 79804 (84.7%) | 70014 (88.2%) | 5618 (67.7%) | 3144 (76.0%) | 1028 (44.1%) | |
| unknown | 494 (0.5%) | 372 (0.5%) | 40 (0.5%) | 20 (0.5%) | 62 (2.7%) | |
NA = not applicable, SD = standard deviation, SDW = separated, divorced or widowed, SEER = Surveillance, Epidemiology, and End Results program.
In the registries of population-based SEER cancer, the incidence of individuals was linked to their mortality outcomes. It could calculate mortality rates by variables like stage at diagnosis determined at diagnosis. This special mortality measure was defined as incidence-based mortality (IBM).[10,11] Relative survival estimates were defined as the ratio of the observed survival of cancer patients and the expected survival of the underlying general population.
2.3. Statistical analysis
Two-sample t tests and Pearson chi-square tests were performed for continuous variables and categorical variables, respectively. Bonferroni correction was applied to adjust P value, and the adjusted P value was.008.[12] The SEER_Stat version 8.3.2 was used to calculate incidence, mortality rates and 1, 3, 5-year relative survival rate of TCCs. Then, joinpoint regression was performed to identify the best-fitting log-linear regression model, which felicitously demonstrated the trend of incidence and mortality rates by era. The National Cancer Institute Joinpoint Regression program, Version 4.6.0.0, was utilized to calculated the annual percent change (APC) and 95% confidence intervals (95% CI).[13] The Joinpoint Regression software utilized t tests to confirm whether statistical difference existing between APC and zero, and P < .05 was considered statistically significant. The Kaplan–Meier method with the log-rank test was performed to examine the survival outcomes between TCCs, and P value <.05 was considered significant. The SPSS 22.0 (IBM Corp, Armonk, NY) and R version 3.6.3 were utilized for all statistical analyses.
3. Results
3.1. Descriptive characteristics of the study population
Finally, 94,187 patients diagnosed with TCC in the urinary system were enrolled in our study. There were 79419 (84.32%), 8298 (8.81%), 4138 (4.39%) and 2332 (2.48%) patients in the urinary bladder, renal pelvis, ureter and urethra subgroups, respectively. Table 1 shows the essential demographic characteristics of patients in each subgroup. The median and mean follow-up times for all urinary system patients were 23 and 43.77 months, respectively. Patients with TCC in the renal pelvis and ureter tended to be older (Mean age 73.10 and 73.19 years, respectively). Male patients were more like to have TCC than female patients. The male-to-female ratio of TCC was 3.1:1, 1.3:1, 1.6:1, 2.96:1, in the urinary bladder, renal pelvis, ureter, and urethra cohorts, respectively. Grade IV tumor was more common in the urinary system (39742,42.2%), and the urinary bladder had a higher percentage of grade IV patients (34254, 43.1%) than other sites in the urinary system. TCC in the renal pelvis had a higher proportion of advanced stage of regional (42.2% vs 16.2%) and distant (35.7% vs 13.4%) stage when compared to the urinary bladder. Surgery is still the main treatment for TCC patients, while the proportion of undergoing surgery was relatively lower in the urethra (44.1%) and renal pelvis (67.7%) cohort. Chemotherapy was the most common adjuvant therapy in TCC patients (25%). No statistical differences on receiving chemotherapy were observed between TCC in the urinary bladder, renal pelvis and ureter. (25.1%, 25.7%, 25.1%; P > .05). The TCC patients with radiotherapy were just accounting for 8.3%.
3.2. Trends in the incidence and mortality rate of transitional cell carcinoma in the urinary system
We observed the highest incidence of TCC in the bladder, and followed by renal pelvis, ureter, and urethra (Fig. 1A). Meanwhile, a slight decrease in incidence was shown in the both bladder and urethra TCCs at a rate of −1.0% (95%CI: −1.4 to −0.6, P < .001) and −2.9% (95%CI: −4.3 to −1.5, P < .001), respectively, for the period of 2000 to 2018. (Table 2, Fig. 2A). A respectively stable trend in incidence was observed in the both renal pelvis and ureter TCCs during study period. (Table 2, Fig. 2A).
Figure 1.
Kaplan–Meier curves of overall survival (OS) (A) and cancer-specific survival (CSS) (B) by locations of urinary tract.
Table 2.
Trend in incidence and incidence-based mortality by location in the urinary system.
| Incidence | Yr of diagnosis | APC (95%CI) | P value |
|---|---|---|---|
| Renal pelvis | 2000–2018 | 0.4% (−0.1 to 1.0) | .1 |
| Ureter | 2000–2018 | −0.3% (−1.0 to 0.5) | .15 |
| Bladder | 2000–2018 | −1.0% (−1.4 to −0.6) | .001 |
| Urethra | 2000–2018 | −2.9% (−4.3 to −1.5) | <.001 |
| Incidence-based mortality | Yr of death | APC (95%CI) | P value |
| Renal pelvis | 2000–2002 | 74% (34.7 to 124.7) | <.001 |
| 2002–2010 | 4.6% (2.6 to 6.6) | <.001 | |
| 2010–2018 | −0.1% (−1.4 to 1.3) | .11 | |
| Ureter | 2000–2002 | 93.1% (29.4 to 188.1) | <.001 |
| 2002–2009 | 6.1% (2.5 to 9.9) | <.001 | |
| 2009–2018 | 0.2% (−1.3 to 1.8) | .15 | |
| Bladder | 2000–2002 | 59.0% (31.3 to 92.6) | <.001 |
| 2002–2010 | 4.4% (2.8 to 6.0) | <.001 | |
| 2010–2018 | −0.1% (−1.1 to 1.0) | .25 | |
| Urethra | 2000–2006 | 15.0% (0.1 to 32.2) | <.001 |
| 2006–2018 | −1.9% (−4.8 to 1.2) | .4 |
APC = annual percent change.
Figure 2.
The age-adjusted incidence and mortality rate of Transitional cell carcinoma is illustrated according to the era of diagnosis stratified by locations of urinary tract; (A) Trends in incidence; (B) Trends in incidence-based mortality.
The IBM rate was the highest in bladder TCC, and followed by renal pelvis, ureter, and urethra (Fig. 2B). Of bladder TCC, an initial rapid increase in IBM rate was observed with the APC of 59.0% (95%CI: 31.3–92.6, P < .001) over 2000 to 2002, then a reduction in the rate of increase occurred in the period of 2002 to 2010 (APC: 4.4%, 95%CI: 2.8–6.0, P < .001). The trend began to stabilize from 2010 to 2018 (Table 2, Fig. 1B). The IBM rate in both renal pelvis and ureter showed an initial rapid increase with the APC of 74% (95%CI: 34.7–124.7, P < .001) and 93.1% (95%CI: 29.4–188.1, P < .001), respectively, from 2000 to 2002. The following was a relatively slow increase at a rate of 4.6% (95%CI: 2.6–6.6, P < .001) and 4.4% (95%CI: 2.8–6.0, P < .001). At the end of study period, the trend was relatively stable. For urethra TCC, the IBM rate continued to increase with the APC of 15.0% (95%CI: 0.1–32.2, P < .001) for 2000 to 2006, and it was stable for the period of 2006 to 2018 (Table 2, Fig. 2B).
3.3. Survival outcomes
The survival curves according to Kaplan-Meier showed that patients with bladder TCC had best survival outcomes of OS and CSS when compared other 3 locations (Fig. 1A and B) In addition, the relatively poorer OS and CSS were observed in the patients with renal pelvis TCC (P < .001) (Fig. 1A and B) In subset analysis stratified by tumor grade, patients with bladder TCC presented better OS and CSS compared with those with TCC in other 3 locations. (Supplemental figure 1, http://links.lww.com/MD/K689).
Table 3 illustrated the relative survival rate of TCC in 4 sites of the urinary system for 1-year, 3-year, 5-year stratified by tumor stage. For all patients, patients with renal pelvis TCC had the lowest 1-year (67.16%), 3-year (43.73%), and 5-year (35.58%) relative survival rate, and we observed the highest 1-year (79.46%), 3-year (59.26%), and 5-year (53.06%) relative survival rate in patients with bladder TCC (Table 3).
Table 3.
1-yr, 3-yr, 5-yr relative survival rate by locations in the urinary system.
| Location | 1-yr survival rate | 3-yr survival rate | 5-yr survival rate |
|---|---|---|---|
| Overall | |||
| Renal pelvis | 53,338 (67.16%) | 34730 (43.73%) | 28257 (35.58%) |
| Ureter | 6095(73.45%) | 3977 (47.93%) | 3154 (38.01%) |
| Bladder | 3288 (79.46%) | 2452 (59.26%) | 2196 (53.06%) |
| Urethra | 1761 (75.51%) | 1143 (49.00%) | 912 (39.11%) |
4. Discussion
Transitional cell carcinoma, as a typical pathological style in the urinary system, can be observed in the great locations in all urinary tract. Although each of the malignancies had been explored individually except for urethra TCC, whose current researches are limited to case reports,[2,8,14,15] there was still lacking considerable data research on the epidemiology of urinary tract TCC together. In our study, Significant differences were discussed detailly between TCCs in the urinary system.
The dominant tumor grade in the urinary tract had been a controversial issue. Part of previous studies suggested that a greater tendency of high-grade TCC was confirmed in the upper urinary tract when compared to bladder TCC.[16,17] Meanwhile, they obtained the results that low-grade TCC tumors had a relatively higher proportion in the bladder. However, in our study, patients with grade IV TCC accounted for nearly half of all bladder TCC patients. (43.2%) In addition, a higher percentage of grade IV TCC patients was found in urinary bladder comparison with renal pelvis and ureter (43.1% vs 35.6% vs 42.1% for urinary bladder, renal pelvis and ureter, respectively, P < .001). The disparity of criterion of the pathology report and sample size might be crucial causes. Interestingly, a retrospective study noted that 33% upper urinary tract TCC presented with stage pT2–T4, while this value was only 20% in the bladder.[17] Our study similarly found that 42.2% and 35.7% renal pelvis TCC patients were classified as the regional and distant stage, respectively, according to SEER Summary stage, compared with only 16.2% and 13.4% in bladder TCC. Upper urinary tract TCC is shown as a more advanced disease than bladder TCC, and more aggressive treatment of upper urinary tract TCC is needed to consider.
Surgery was still the primary treatment for urinary tract TCC patients, and 84.7% of patients had undergone surgery. However, for renal pelvis and urethra TCC patients, 31.8% and 53.3% cases failed to receive surgery. The difficulty in thoroughly staging might be the primary obstruction factor. Chemotherapy and radiotherapy were the crucial part of adjuvant therapy. A study based on the SEER database (2004–2013) showed that only 16% patients with non-metastatic UTUC patients received perioperative chemotherapy.[18] The effect of perioperative chemotherapy for bladder TCC patients was affirmed. In contrast, UTUC patients reached conflicting results from several retrospective studies.[2,14,18,19] The proportion of TCC patients receiving chemotherapy was 25.0% in our study. No statistical differences were observed between the urinary bladder, renal pelvis, and ureter TCC patients. Although chemotherapy utilization seemed infrequent, it had increased steadily and been taken seriously, especially for UTUC. Radiotherapy utilization was still in the exploratory stage, and only 8.3% of TCC patients had received radiotherapy.[2,4]
The incidence of TCC in the bladder and urethra continues to decrease steadily by era, and no prominent changes in incidence were presented in renal pelvis and ureter. However, the mortality rate of 4 locations TCC exhibited an increasing trend in the same period. The change in the smoking rate in the United States might be an essential explanation for the phenomenon. Tobacco smoking is the primary risk factor for TCC patients, and a reported result showed ever-smokers had a 2.5 times higher risk for malignant TCC than nonsmokers.[20] In addition, nearly 55% of new cases in the United States were considered to associate with smoking.[21] According to National Health Surveys, about 42% of American adults were smokers in 1965, and this rate remained relatively high in the 1970s and 1980s.[22,23] This high smoking rate might be one of the important reasons for the increase mortality rate. A reported data from the SEER database showed a significant increase in incidence of bladder TCC during 1997 to 2007 [21]. The smoking prevalence in men had markedly decreased over the past several decades in North America.[22] This might be why we can observe a more stable incidence and mortality rate in the end of study period. Notably, the mortality had lagged effect on incidence rate for the effect of the change in smoking rate on account the incidence rate is often recorded before death rate for 1 case.[22,24]
The relationship between survival outcome and tumor location of the urinary tract was a worth exploring and interesting topic all the time. For example, A retrospective study with 6827 upper and lower tract urothelial carcinoma patients aimed to analyze the impact of location of the urinary tract on oncologic outcomes, and they noticed that bladder TCC in non–muscle-invasive tumor stages patients were more likely to suffer disease recurrence and mortality in comparison with those with renal pelvicalyceal TCC.[25] However, a study based on the National Cancer Database obtained inconsistent conclusions.[26] Our study analyzed the survival outcome between TCC location in the urinary tract by comparing survival rate for 1-, 3-, 5-year and survival time. Among the 4 sites TCC, bladder TCC patients had the best OS and CSS and the worse OS and CSS were observed in renal pelvis TCC patients. Similar results were acquired in the subgroup of Grade III and Grade IV. It seemed reasonable that different locations TCC presented different prognoses considering embryological, genetic, and anatomical differences that existed between them.[27] The more acceptable explanation is the differences in our technical ability to accurately stage and treat for these diseases. For example, the technical limitations of UTUC sampling compared to transurethral resection for urothelial carcinoma of the bladder were the most important source of staging differences between the 2 diseases.[6] Therefore, compared with UTUC, the diagnostic stage of bladder TCC tended to be early. However, the reasons these studies failed to get a consistent result might be patients’ select bias and limited by retrospective studies. A prospective study with a larger sample size and a more rigorous design is needed to verify these results.
Like other population-based analyses, our study is subject to the usual limits of these data in the SEER database. First, some essential variables have not been described in detail. For upper tract urothelial carcinoma usually contains the renal pelvis and ureter. However, the SEER database integrates the kidney with the renal pelvis, although TCC is relatively rare in the kidney. Meanwhile, urethra were also a relatively vague definition, even though we have endeavored to explain its contents. In addition, owing to lacking detailed information on TNM stage, tumor size and metastatic spread, we cannot further risk stratify patients to evaluate survival outcomes between different sites. Moreover, for treatment of TCC, we just access the proportion of receiving treatment, including radiotherapy, chemotherapy and surgery, but miss the data of chemotherapy regimens, radiotherapy target and dose, and surgical approach. Finally, although we aim to investigate TCC incidence by race, some statistics of AIAN and API are failed to obtain on account of a small number of cases.
5. Conclusion
This is the first to our knowledge study that comprehensively evaluates transitional cell carcinoma in different locations of the urinary system. There are still significant differences between different locations of TCC in the urinary system, although they have the same histology. Principal epidemiologic trends and meticulously describing survival outcomes are essential for patient counseling and changing treatment mode. Notably, patients with bladder TCC especially for localized stage have a better survival outcome than those with UTUC. These disparities are especially essential when we explore tumor characteristics and treatment, extrapolated from the literature on bladder urothelial carcinoma for upper tract urothelial carcinoma.
Acknowledgments
This statement is to certify that all authors have approved the manuscript being submitted, have contributed significantly to the work, attest to the validity and legitimacy of the data and its interpretation.
Author contribution
Conceptualization: Xiaofeng Tang, Xiangpeng Zhan, Xiaomin Chen.
Data curation: Xiaofeng Tang, Xiangpeng Zhan, Xiaomin Chen.
Formal analysis: Xiaofeng Tang, Xiangpeng Zhan, Xiaomin Chen.
Supplementary Material
Abbreviations:
- APC
- annual percent change
- CSS
- cancer-specific survival
- IBM
- incidence-based mortality
- OS
- overall survival
- SEER
- surveillance, epidemiology, and end results
- TCC
- transitional cell carcinoma
- UC
- urothelial carcinoma
- UTUC
- upper tract urothelial carcinoma
Ethical approval statement: The data from SEER is publicly available and de-identified. Consent is not requested.
The datasets generated during and/or analyzed during the current study are publicly available.
Supplemental Digital Content is available for this article.
The authors have no conflicts of interest to disclose.
How to cite this article: Tang X, Zhan X, Chen X. Incidence, mortality and survival of transitional cell carcinoma in the urinary system: A population-based analysis. Medicine 2023;102:46(e36063).
Contributor Information
Xiangpeng Zhan, Email: 1224439512@qq.com.
Xiaomin Chen, Email: chenxm2012@126.com.
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