Skip to main content

Advertisement

SpringerLink
Log in

Socio-economic deprivation and outcomes following radical nephroureterectomy for clinically localized upper tract transitional cell carcinoma

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Background

Little is known about the effects of socio-economic deprivation on the oncological outcomes of surgically treated upper tract transitional cell carcinoma.

Methods

From January 1998 to December 2012, 161 patients underwent nephroureterectomy for upper urinary tract cancer at our tertiary medical centre. We included 124 patients where complete data were available for further analysis. This study also analysed the impact of the reported risk factors such as grade, stage, multifocality in addition to socio-economic deprivation on the long-term oncological outcomes after nephroureterectomy.

Results

One hundred and twenty-four (77 %) patients with complete data for socio-economic status were analysed in this study. The median age of the cohort was 73 years (interquartile range 45–86). There were 20, 18, 17, 40 and 29 patients in different socio-economic categories ranging from 1 to 5, respectively. The median duration of follow-up was 68 months (9–174). A statistically higher grade (p value 0.005) and higher stage (p value 0.0005) disease was seen in patients from less deprived categories on both univariate and multivariate analyses. The cancer-specific mortality and follow-up recurrences, however, did not significantly differ between the different socio-economic categories on multivariate analysis (p value 0.13; 0.6) and on univariate and multivariate analyses. A higher number of patients with multifocal disease and concomitant carcinoma in situ (CIS) had disease recurrences which were statistically significant (p values 0.026 and 0.014, respectively) on multivariate analysis.

Conclusions

A lower recurrence-free survival was observed in patients with multifocal disease and those with concomitant CIS following nephroureterectomy for clinically localized disease. Long-term follow-up did not show any significant differences in cancer-specific survival between different deprivation categories.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Rai BP, Shelley M, Coles B, Somani B, Nabi G (2012) Surgical management for upper urinary tract transitional cell carcinoma (UUT-TCC): a systematic review. BJU Int 110:1426–1435

    Article  PubMed  Google Scholar 

  2. Hall MC, Womack S, Sagalowsky AI, Carmody T, Erickstad MD, Roehrborn CG (1998) Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients. Urology 52:594–601

    Article  CAS  PubMed  Google Scholar 

  3. Eylert MF, Hounsome L, Verne J, Bahl A, Jefferies ER, Persad RA (2013) Prognosis is deteriorating for upper tract urothelial cancer: data for England 1985-2010. BJU Int 112:E107–E113

    Article  PubMed  Google Scholar 

  4. Coleman MP, Rachet B, Woods LM, Mitry E, Riga M, Cooper N, Quinn MJ, Brenner H, Esteve J (2004) Trends and socioeconomic inequalities in cancer survival in England and Wales up to 2001. Br J Cancer 90:1367–1373

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Ayanian JZ, Carethers JM (2012) Bridging behavior and biology to reduce socioeconomic disparities in colorectal cancer risk. J Natl Cancer Inst 104:1343–1344

    Article  PubMed  Google Scholar 

  6. Akinyemiju TF, Soliman AS, Johnson NJ, Altekruse SF, Welch K, Banerjee M, Schwartz K, Merajver S (2013) Individual and neighborhood socioeconomic status and healthcare resources in relation to black-white breast cancer survival disparities. J Cancer Epidemiol 2013:490472

    PubMed Central  PubMed  Google Scholar 

  7. Kahn KL, Pearson ML, Harrison ER, Desmond KA, Rogers WH, Rubenstein LV, Brook RH, Keeler EB (1994) Health care for black and poor hospitalized Medicare patients. JAMA 271:1169–1174

    Article  CAS  PubMed  Google Scholar 

  8. Moore RD, Stanton D, Gopalan R, Chaisson RE (1994) Racial differences in the use of drug therapy for HIV disease in an urban community. N Engl J Med 330:763–768

    Article  CAS  PubMed  Google Scholar 

  9. Yergan J, Flood AB, LoGerfo JP, Diehr P (1987) Relationship between patient race and the intensity of hospital services. Med Care 25:592–603

    Article  CAS  PubMed  Google Scholar 

  10. Evans R, Roos NP (1999) What is right about the Canadian health care system? Milbank Q 77(393–9):276

    Google Scholar 

  11. Starfield B (2000) Is US health really the best in the world? JAMA 284:483–485

    Article  CAS  PubMed  Google Scholar 

  12. Starfield B, Paganini JM (2000) Is equity a scientific issue? J Epidemiol Community Health 54:324–325

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Susser M (1993) Health as a human right: an epidemiologist’s perspective on the public health. Am J Public Health 83:418–426

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Marmot MG, Kogevinas M, Elston MA (1987) Social/economic status and disease. Annu Rev Public Health 8:111–135

    Article  CAS  PubMed  Google Scholar 

  15. Epstein JI, Amin MB, Reuter VR, Mostofi FK (1998) The World Health Organization/International Society of Urological Pathology consensus classification of urothelial (transitional cell) neoplasms of the urinary bladder. Bladder Consensus Conference Committee. Am J Surg Pathol 22:1435–1448

    Article  CAS  PubMed  Google Scholar 

  16. Gillan A, Alexander E, Townell N, Nabi G (2013) Laparoscopic en bloc resection of ureter with a cuff of bladder during radical nephroureterectomy for lower ureteric tumors: a matched-paired analysis. J Laparoendosc Adv Surg Tech A 23:626–631

    Article  PubMed  Google Scholar 

  17. Leonard M, Tait CD, Gillan AS, Rai BP, Byrne DJ, Nabi G, TUCAN Group in Tayside (2013) Impact of multiple deprivations on detection, progression and interventions in small renal masses (less than 4 cm) in a population based study. Eur J Surg Oncol

  18. Morgan RM, Steele RJ, Nabi G, McCowan C (2013) Socioeconomic variation and prostate specific antigen testing in the community: a united kingdom based population study. J Urol

  19. Oliphant R, Nicholson GA, Horgan PG, Molloy RG, McMillan DC, Morrison DS, West of Scotland Colorectal Cancer Managed Clinical Network (2013) Deprivation and colorectal cancer surgery: longer-term survival inequalities are due to differential postoperative mortality between socioeconomic groups. Ann Surg Oncol 20:2132–2139

    Article  PubMed  Google Scholar 

  20. Ganeswaran D, Sweeney C, Yousif F, Lang S, Goodman C, Nabi G (2012) Population-based linkage of health records to detect urological complications and hospitalisation following transrectal ultrasound-guided biopsies in men suspected of prostate cancer. World J Urol

  21. El-Mokadem I, Budak M, Pillai S, Lang S, Doull R, Goodman C, Nabi G (2013) Progression, interobserver agreement, and malignancy rate in complex renal cysts (Bosniak category IIF). Urol Oncol

  22. Hagiwara M, Kikuchi E, Tanaka N, Matsumoto K, Ide H, Miyajima A, Masuda T, Nakamura S, Oya M (2013) Impact of smoking status on bladder tumor recurrence after radical nephroureterectomy for upper tract urothelial carcinoma. J Urol 189:2062–2068

    Article  PubMed  Google Scholar 

  23. Clegg LX, Reichman ME, Miller BA, Hankey BF, Singh GK, Lin YD, Goodman MT, Lynch CF, Schwartz SM, Chen VW, Bernstein L, Gomez SL, Graff JJ, Lin CC, Johnson NJ, Edwards BK (2009) Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: national Longitudinal Mortality Study. Cancer Causes Control 20:417–435

    Article  PubMed  Google Scholar 

  24. Kogevinas M, Porta M (1997) Socioeconomic differences in cancer survival: a review of the evidence. IARC Sci Publ 138:177–206

    PubMed  Google Scholar 

  25. Woods LM, Rachet B, O’Connell DL, Lawrence G, Tracey E, Willmore A, Coleman MP (2010) Differences in breast cancer incidence in Australia and England by age, extent of disease and deprivation status: women diagnosed 1980-2002. Aust N Z J Public Health 34:206–213

    Article  PubMed  Google Scholar 

  26. Green DA, Rink M, Xylinas E, Matin SF, Stenzl A, Roupret M, Karakiewicz PI, Scherr DS, Shariat SF (2013) Urothelial carcinoma of the bladder and the upper tract: disparate twins. J Urol 189:1214–1221

    Article  PubMed  Google Scholar 

  27. Li CC, Chang TH, Wu WJ, Ke HL, Huang SP, Tsai PC, Chang SJ, Shen JT, Chou YH, Huang CH (2008) Significant predictive factors for prognosis of primary upper urinary tract cancer after radical nephroureterectomy in Taiwanese patients. Eur Urol 54:1127–1134

    Article  PubMed  Google Scholar 

  28. Chromecki TF, Cha EK, Fajkovic H, Margulis V, Novara G, Scherr DS, Lotan Y, Raman JD, Kassouf W, Bensalah K, Weizer A, Kikuchi E, Roscigno M, Remzi M, Matsumoto K, Walton TJ, Pycha A, Ficarra V, Karakiewicz PI, Zigeuner R, Pummer K, Shariat SF (2012) The impact of tumor multifocality on outcomes in patients treated with radical nephroureterectomy. Eur Urol 61:245–253

    Article  PubMed  Google Scholar 

  29. Rink M, Xylinas E, Margulis V, Cha EK, Ehdaie B, Raman JD, Chun FK, Matsumoto K, Lotan Y, Furberg H, Babjuk M, Pycha A, Wood CG, Karakiewicz PI, Fisch M, Scherr DS, Shariat SF, Upper Tract Urothelial Carcinoma Collaboration (2013) Impact of smoking on oncologic outcomes of upper tract urothelial carcinoma after radical nephroureterectomy. Eur Urol 63:1082–1090

    Article  PubMed Central  PubMed  Google Scholar 

  30. Ehdaie B, Furberg H, Zabor EC, Ostroff JS, Shariat SF, Bochner BH, Coleman JA, Dalbagni G (2013) Impact of smoking status at diagnosis on disease recurrence and death in upper tract urothelial carcinoma. BJU Int 111:589–595

    Article  PubMed Central  PubMed  Google Scholar 

  31. Tang L, Zirpoli GR, Guru K, Moysich KB, Zhang Y, Ambrosone CB, McCann SE (2008) Consumption of raw cruciferous vegetables is inversely associated with bladder cancer risk. Cancer Epidemiol Biomarkers Prev 17:938–944

    Article  CAS  PubMed  Google Scholar 

  32. Michaud DS, Spiegelman D, Clinton SK, Rimm EB, Willett WC, Giovannucci EL (1999) Fruit and vegetable intake and incidence of bladder cancer in a male prospective cohort. J Natl Cancer Inst 91:605–613

    Article  CAS  PubMed  Google Scholar 

  33. Zeegers MP, Kellen E, Buntinx F, van den Brandt PA (2004) The association between smoking, beverage consumption, diet and bladder cancer: a systematic literature review. World J Urol 21:392–401

    Article  PubMed  Google Scholar 

  34. Begum G, Dunn JA, Bryan RT, Bathers S, Wallace DM, West Midlands Urological Research Group (2004) Socio-economic deprivation and survival in bladder cancer. BJU Int 94:539–543

    Article  PubMed  Google Scholar 

  35. Lughezzani G, Sun M, Perrotte P, Shariat SF, Jeldres C, Budaus L, Latour M, Widmer H, Duclos A, Benard F, McCormack M, Montorsi F, Karakiewicz PI (2010) Gender-related differences in patients with stage I to III upper tract urothelial carcinoma: results from the Surveillance, Epidemiology, and End Results database. Urology 75:321–327

    Article  PubMed  Google Scholar 

  36. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None

Author information

Authors and Affiliations

  1. Academic Section of Urology, Division of Imaging and Technology, Medical Research Institute, Medical School, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, Scotland, UK

    R. Mehta, A. S. Gillan, Z. Y. Ming, B. P. Rai, D. Byrne & G. Nabi

Authors
  1. R. Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. S. Gillan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Z. Y. Ming
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. P. Rai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Byrne
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Nabi
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Tayside Urological Cancers Network, Dundee, Scotland

Corresponding author

Correspondence to G. Nabi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mehta, R., Gillan, A.S., Ming, Z.Y. et al. Socio-economic deprivation and outcomes following radical nephroureterectomy for clinically localized upper tract transitional cell carcinoma. World J Urol 33, 41–49 (2015). https://doi.org/10.1007/s00345-014-1262-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-014-1262-0

Keywords

Search

Navigation