Exploring contemporary trends in diagnosis, stage and treatment outcomes for upper tract urothelial cancer (UTUC) and non-urothelial cancer (nUC) upper tract: A National Cancer Database (NCDB) analysis.

Abstract

e16558 Background: Upper tract cancers (UTC) make up a rare population of genitourinary tumors that tends to be more aggressive in presentation. Histologies can be either urothelial cancer (UC) or non-urothelial cancer (nUC) which includes squamous, sarcomatoid, small cell or neuroendocrine, and adenocarcinoma. Exploration of differences between diagnostic and treatment patterns are sought. Methods: Patient-level data extraction from NCDB was obtained between 2004 to 2020, we describe the differences between demographic, clinical characteristics, staging and treatment for both UC and nUC UTC. Results: There were 23453 patients (pts) (62%) Males (M) and 14381 (38%) Females (F) in the entire cohort, of whom majority 23064 (62.1%, M) and 14103 (37.9%, F) had UC and only 389 (58.3%, M) and 278 (41.7%, F) had nUC. Majority of UC pts 34075, 91.7%, were White (W), 1443 (3.9%) were Black (B) and nUC pts had 594 (89.1%) W and 39 (5.8%) B. Majority of UC pts were treated in comprehensive community cancer programs (38% and 38.8% in both UC and nUC pts) followed by academic/research programs (35.7 and 33.9%, respectively). Medicare was the primary payer in 71.7% and 69.1% of UC and nUC pts, respectively, followed by private insurance in 21.9% in both UC and nUC pts. Majority had Charlson-Deyo Score of 0 at 23969 (64.5%, UC) and 441 (66.1%, nUC). Stage 0 was the most common stage at diagnosis for UC with 12938 pts (34.8%), whereas the incidence of advanced-stage cancer was higher in nUC, with Stage III occurring in 141 pts (21.1% nUC) vs UC at 4324 pts (11.6%) and stage IV occurring in 240 pts (36.0% nUC) and 4420 pts (11.9% UC). Median overall survival (mOS) for Stage 0 & I UC pts = 80.53 mos (CI, 78.13, 83.25) vs nUC = 28.98 mos (CI, 20.3, 46.78), Logrank p < 0.0001; Stage II & III UC pts mOS = 35.65 mos (CI, 33.38, 38.05) vs nUC = 15.75 mos (CI,11.17, 26.87), Logrank p = 0.0037; but no difference in Stage IV UC pts = 8.57 mos (CI, 8.05, 9.10) vs nUC = 7 mos (CI, 5.62, 9.26), Logrank p = 0.2983. Surgical treatment mOS for UC pts = 67.84 mos (CI, 65.84, 69.62) vs nUC = 18.66 mos (CI, 15.57, 23.59), Logrank p < 0.0001; Chemotherapy mOS for UC pts = 32.16 mos (CI, 30.85, 33.94) vs nUC pts = 13.01 mos (CI, 10.71, 16.39), Logrank p < 0.0001, while immunotherapy mOS for UC pts = 59.60 mos (CI, 52.37, 70.18) vs nUC = 17.59 mos (CI, 9.13, NE), Logrank p = 0.0022. Conclusions: Our analyses of UTC reveals better mOS overall for UC compared to nUC especially in lower stages 0 & I, Stage II & III but not in stage IV cancers. Treatment with surgery, chemotherapy, or immunotherapy improved mOS in UC compared to nUC patients. This study highlights worse overall prognosis in nUC UTC that warrants continued search for better therapeutics.