Cause of death during upper tract urothelial carcinoma survivorship: A contemporary, population-based analysis

Fu-Sheng Peng; Wan-Ting Wu; Lu Zhang; Jia-Hua Shen; Dong-Dong Yu; Li-Qi Mao

doi:10.3389/fonc.2022.948289

Cause of death during upper tract urothelial carcinoma survivorship: A contemporary, population-based analysis

Front Oncol. 2022 Oct 28:12:948289. doi: 10.3389/fonc.2022.948289. eCollection 2022.

Authors

Fu-Sheng Peng¹, Wan-Ting Wu², Lu Zhang², Jia-Hua Shen³, Dong-Dong Yu¹, Li-Qi Mao⁴

Affiliations

¹ Department of Urology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China.
² Major of Clinical Medicine, Huzhou University, Huzhou, China.
³ Department of Medical Insurance Fund Supervision Section, Huzhou Wu-xing District Medical Insurance Management Service Center, Huzhou, China.
⁴ Department of Gastroenterology, The First People's Hospital of Huzhou, First Affiliated Hospital of Huzhou University, Huzhou, China.

Abstract

Background: Very few studies have been published on the causes of death of upper tract urothelial carcinoma (UTUC). We sought to explore the mortality patterns of contemporary UTUC survivors.

Methods: We performed a retrospective cohort study involving patients with upper urinary tract carcinoma from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database (2000 and 2015). We used standardized mortality ratios (SMRs) to compare death rates among patients with UTUC in the general population and excess absolute risks (EARs) to quantify the disease-specific death burden.

Results: A total of 10,179 patients with UTUC, including 7,133 who died, were included in our study. In total, 302 (17.17%) patients with the localized disease died of UTUC; however, patients who died from other causes were 4.8 times more likely to die from UTUC (n = 1,457 [82.83%]). Cardiovascular disease was the most common non-cancer cause of death (n = 393 [22.34% of all deaths]); SMR, 1.22; 95% confidence intervals [CI], 1.1-1.35; EAR, 35.96). A total of 4,046 (69.99%) patients with regional stage died within their follow-up, 1,413 (34.92%) of whom died from UTUC and 1,082 (26.74%) of whom died from non-cancer causes. UTUC was the main cause of death (SMR, 242.48; 95% CI, 230-255.47; EAR, 542.47), followed by non-tumor causes (SMR, 1.18; 95% CI, 1.11-1.25; EAR, 63.74). Most patients (94.94%) with distant stage died within 3 years of initial diagnosis. Although UTUC was the leading cause of death (n = 721 [54.29%]), these patients also had a higher risk of death from non-cancer than the general population (SMR, 2.08; 95% CI, 1.67-2.56; EAR, 288.26).

Conclusions: Non-UTUC deaths accounted for 82.48% of UTUC survivors among those with localized disease. Patients with regional/distant stages were most likely to die of UTUC; however, there is an increased risk of dying from non-cancer causes that cannot be ignored. These data provide the latest and most comprehensive assessment of the causes of death in patients with UTUC.

Keywords: cause of death; excess absolute risks (EARs); standardized mortality ratios (SMRs); surveillance epidemiology and end results (SEER); upper urinary tract carcinoma.