World journal of urology · 2024
Squamous cell carcinoma of the upper urinary tract: clinical characteristics, treatment patterns, and survival outcomes in the National Cancer Database.
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Connors Christopher, Omidele Olamide, Tomer Nir, Levy Micah, Mehrazin Reza, Badani Ketan, Sfakianos John P
Аннотация
PURPOSE: We sought to investigate the disease characteristics, treatment patterns, and survival outcomes of upper urinary tract squamous cell carcinoma (UT-SCC) using the National Cancer Database (NCDB).
METHODS: The NCDB was queried for UT-SCC patients from 2004 to 2020. Patients with upper tract urothelial carcinoma (UTUC) were also identified for comparison with UT-SCC. Baseline characteristics were compared between UT-SCC and UTUC patients. Kaplan-Meier analysis assessed stage-based differences in median overall survival (mOS) between 1:4 propensity-matched cohorts of UT-SCC and UTUC patients. Predictors of mortality were assessed via multivariate cox regression.
RESULTS: 644 cases of UT-SCC and 55,994 cases of UTUC were identified. Compared to UTUC, UT-SCC patients were more likely to have a higher TNM stage, lymphovascular invasion, and positive surgical margins. UT-SCC demonstrated a comparable mOS to UTUC for non-metastatic T1-T2 disease (74.84 vs. 106.38 months, p = 0.353) and metastatic disease (5.62 vs. 7.16 months, p = 0.058). However, UT-SCC carried a poorer prognosis for carcinoma in situ (45.14 vs. 69.32 months, p = 0.032) and non-metastatic T3-T4 disease (13.63 vs. 31.93 months, p < 0.001). Moreover, we found increasing T stage, metastatic disease, and positive surgical margins to be significant predictors of UT-SCC mortality. Lastly, we found that surgery does not confer a survival benefit over other management strategies for metastatic UT-SCC.
CONCLUSIONS: UT-SCC is a rare, aggressive malignancy that typically presents with a more advanced stage than UTUC. Surgical margin status may represent one of the most salient predictors of UT-SCC mortality. Further studies are needed to best define treatment strategy for this uncommon malignancy.
METHODS: The NCDB was queried for UT-SCC patients from 2004 to 2020. Patients with upper tract urothelial carcinoma (UTUC) were also identified for comparison with UT-SCC. Baseline characteristics were compared between UT-SCC and UTUC patients. Kaplan-Meier analysis assessed stage-based differences in median overall survival (mOS) between 1:4 propensity-matched cohorts of UT-SCC and UTUC patients. Predictors of mortality were assessed via multivariate cox regression.
RESULTS: 644 cases of UT-SCC and 55,994 cases of UTUC were identified. Compared to UTUC, UT-SCC patients were more likely to have a higher TNM stage, lymphovascular invasion, and positive surgical margins. UT-SCC demonstrated a comparable mOS to UTUC for non-metastatic T1-T2 disease (74.84 vs. 106.38 months, p = 0.353) and metastatic disease (5.62 vs. 7.16 months, p = 0.058). However, UT-SCC carried a poorer prognosis for carcinoma in situ (45.14 vs. 69.32 months, p = 0.032) and non-metastatic T3-T4 disease (13.63 vs. 31.93 months, p < 0.001). Moreover, we found increasing T stage, metastatic disease, and positive surgical margins to be significant predictors of UT-SCC mortality. Lastly, we found that surgery does not confer a survival benefit over other management strategies for metastatic UT-SCC.
CONCLUSIONS: UT-SCC is a rare, aggressive malignancy that typically presents with a more advanced stage than UTUC. Surgical margin status may represent one of the most salient predictors of UT-SCC mortality. Further studies are needed to best define treatment strategy for this uncommon malignancy.