Session: PD46: Bladder Cancer: Upper Tract Transitional Cell Carcinoma II
PD46-09: Is there a racial disparity in the outcomes of patients with non-metastatic upper tract urothelial carcinoma who are treated surgically? A north american nationwide analysis
Introduction: Non-Hispanic Black (NHB) patients with urological cancers, such as prostate or bladder cancer, have been reported to have worse survival outcomes than their Non-Hispanic White (NHW) counterparts. While the reasons for these differences are still controversial, it is plausible that both access to care and genetics play an important role. Our aim is to examine the impact of race on the overall survival (OS) of surgically treated patient with Upper Tract Urothelial Carcinoma (UTUC). Methods: Our cohort included 9750 cM0 UTUC patients who underwent a radical nephroureterectomy (RNU), between 2004 and 2015, within the National Cancer Database (NCDB). The main variable of interest was race, and it was categorized as NHW, NHB, and others. Kaplan-Meier curves and log-rank test were used to depict and compare survival curves. Cox regression analysis tested the impact of race on OS after accounting for available covariates: age, sex, year of diagnosis Charlson Comorbidity Index, income, treatment center type, insurance status, pathological tumor stage, nodal stage, and pathological LVI status. P-values <0.001 were determined to be significant. Results: Mean (SD) ages at diagnosis for NHW, NHB, and other race were 71.1(10.8), 66.9(12.1), and 71.09(10.9), respectively. Overall, NHW, NHB, and other race was reported in 92.4%, 4.30%, and 3.34%, respectively. The rate of advanced stage (pT3 or higher), pN+ disease, and LVI was respectively 39.0%, 5.77%, and 14.5% in NHW, 41.5%, 0.32%, and 13.0% in NHB, and 39.6%, 0.217%, and 16.7% in other race. The mean (SD) follow-up was 42.86±35.3 months. At 5-years, the OS rate was 49.3% in NHW, vs. 46.8% in NHB, and 53.6% in other race (p=0.254). On multivariable analysis, NHB was not an independent predictor of OS outcomes (HR: 1.30, 95% CI: 1.10-1.56, p=0.015), and neither was other (HR 0.90, 95% CI: 0.71-1.15, p=0.015). Conclusions: Our results indicate that in patients with UTUC treated surgically, NHB patients don’t have a higher stage at diagnosis, and they have similar OS to their NHW counterparts. This is different from other urological cancers, such as prostate cancer where they are very significant differences in terms stage at diagnosis and OS based on race favoring NHW patients. SOURCE OF Funding: None
