Monday July 01, 2019 from 07:30 to 09:00
Disparities associated with disease presentation and poor survival among Asian patients with upper tract urothelial carcinoma
Dixon Woon1, Jaime O. Herrera-Cáceres1, Zachary Klaassen1, Hanan Goldberg1, Thenappan Chandrasekar1, Guan Hee Tan1, Khaled Ajib1, Greg Nason1, Omar Alhunaidi1, Girish S. Kulkarni1, Neil E. Fleshner1.
1Surgical Oncology, University Health Network, Toronto, ON, Canada
Introduction: In most cancers, minority populations, such as African Americans and Hispanics, have shown poorer outcomes than Caucasians. To our knowledge, most epidemiological data on upper tract urothelial cancer (UTUC) has mainly focused on African Americans and Caucasians, and thus neglected the Asian populations, which represent >5% of the U.S. population and are rapidly increasing. Our study aimed to evaluate potential differences in disease stage at diagnosis, surgical management for localized disease, and survival outcomes for Asian patients with UTUC.
Methods: Patients diagnosed with UTUC from 1988–2014 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Demographic and socioeconomic variables, such as marital and insurance status, were analyzed. Multivariable logistic regression was used to assess predictors of metastatic disease at diagnosis. Fine and Gray competing risks analyses were used to identify predictors of cancer-specific mortality (CSM) and Cox proportional hazard models was performed to evaluate overall survival (OS).
Results: A total of 12 124 patients with UTUC were identified. Of these, 10 638 (87.7%) were Caucasians, 793 (6.5%) Asian, 578 (4.8%) African American, and 115 (1%) patients of other races; 1193 (9.8%) patients had metastasis at diagnosis. Rates of Caucasian and Asian patients who presented with metastatic disease at diagnosis were 9.5% and 12.6%, respectively. Compared to Caucasian patients, Asians were 38% (odds ratio [OR] 1.38; 95% confidence interval [CI] 1.1–1.7) more likely to present with metastatic disease and were 27% more likely to die of UTUC (hazard ratio [HR] 1.27; 95% CI 1.1–1.5). There were no differences in surgical management or OS between Caucasians and Asians.
Conclusions: Asian patients with UTUC are more likely to present with metastatic disease at diagnosis and have worse CSM compared to Caucasian patients. Further research should be conducted to evaluate the underlying reason for these findings in order to improve the outcomes for Asian patients with UTUC.