Unusually high incidence of upper urinary tract urothelial carcinoma in Taiwan

Objectives. Unusually high incidences of upper urinary tract urothelial carcinoma (UUT-UC) have been reported from the endemic area for "blackfoot disease" of southern Taiwan, and the arsenic-contaminated water was considered to be the reason for this prevalence. In this study, we determined the ratio of UC in different locations, the difference in clinical profiles for UUT-UC and urinary-bladder urothelial carcinoma (UB-UC), and the influence of tumor location on survival in a medical center of northern Taiwan. Methods. A total of 535 patients with pathologically proven UC were reviewed retrospectively in this study, and clinical data were recorded from pathologic and chart reviews. Statistical analyses to determine the association between tumor location and clinical variables, and stratified survival analyses to determine the effect of tumor location on survival were performed. Results. The incidence of UUT-UC was relatively high (the ratio of renal pelvis/ureter/urinary bladder was 1:2.08:6.72), even though most of the patients did not reside in the endemic "blackfoot disease" area. Young age, female sex, higher T stage, and elevated pretreatment serum lactate dehydrogenase and creatinine level were significantly associated with UUT-UC after multivariate logistic regression analysis. Tumor location influenced survival in patients with early-stage disease or favorable prognostic factors. Conclusions. Factors other than arsenic water contamination may contribute to the unusually high incidence of UUT-UC in the non-"blackfoot disease" area in Taiwan. UUT-UC carried a more aggressively clinical behavior than UB-UC; tumor location influences patient survival markedly in patients with early-stage disease or favorable prognostic factors.