Diagnostic pathways and treatment strategies in upper tract urothelial carcinoma in Sweden between 2015 and 2021: a population-based survey

Fredrik Liedberg; Oskar Hagberg; Firas Aljabery; Truls Gårdmark; Staffan Jahnson; Tomas Jerlström; Viveka Ströck; Karin Söderkvist; Anders Ullén; Johannes Bobjer

doi:10.2340/sju.v59.16281

Authors

Fredrik Liedberg Department of Urology Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden. https://orcid.org/0000-0001-8193-0370
Oskar Hagberg Institution of Translational Medicine, Lund University, Malmö, Sweden.
Firas Aljabery Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden.
Truls Gårdmark Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden https://orcid.org/0000-0003-4610-0771
Staffan Jahnson Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden https://orcid.org/0000-0001-8012-2742
Tomas Jerlström Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden;
Viveka Ströck Department of Urology, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden https://orcid.org/0000-0003-2050-6466
Karin Söderkvist Department of Radiation Sciencies, Umeå University https://orcid.org/0000-0002-3683-3763
Anders Ullén Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Genitourinary Oncology and Urology unit, Karolinska University Hospital, Stockholm, Sweden.
Johannes Bobjer Department of Urology Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden https://orcid.org/0000-0001-8495-3498

DOI:

https://doi.org/10.2340/sju.v59.16281

Abstract

Objective: To report national data on diagnostics and treatment of upper tract urothelial carcinoma (UTUC) from the Swedish National Registry of Urinary Bladder Cancer (SNRUBC).

Patients and methods: Data from 2015 to 2021 were retrieved, and descriptive analyses were performed regarding incidence, diagnostic modalities, preoperative tumor staging, quality indicators for treatment including the use of standardized care pathways (SCP) and multidisciplinary tumor boards (MDTB). Time trends were explored for the study period.

Results: Registrations included 1,213 patients with renal pelvic cancer and 911 patients with ureteric cancer with a median age of 74 (interquartile range [IQR] 70–77) and 75 (IQR 71–78) years, respectively. Incidence rates of UTUC were stable, as were proportions of curative treatment intent. Median number of days from referral to treatment was 76 (IQR 57–99) and 90 (IQR 72–118) days, respectively, for tumors of the renal pelvis and ureter, which remained unchanged after introduction of SCP in 2016. Noticeable trends included stable use of kidney-sparing surgery and increased use of MDTB. For radical nephroureterectomy (RNU), robot-assisted technique usage increased even for non-organ-confined tumors (cT3-4) and in one out of three patients undergoing RNU a bladder cuff excision was not registered.

Conclusions: The population-based SNRUBC with high coverage contributes to the knowledge about UTUC with granular and generalizable data. The present study reveals a high proportion of patients not subjected to curatively intended treatment and suggests unmet needs to shorten lead times to treatment and use of bladder cuff excision when performing radical surgery for UTUC in Sweden.

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