Survival Of Patients With Non-urothelial Carcinoma Of The Upper Urinary Tract

ObjectivesDue to the rarity of non-urothelial tumors of the upper urinary tract,there are few studies on them.The purpose of this article is to study the differences in tumor specificity,treatment and prognosis between non-urothelial tumors of the upper urinary tract and urothelial tumors,so as to provide a reference for the treatment of non-urothelial tumors.MethodsWe analyzed the Surveillance,Epidemiology and End Results database for patients with complete follow-up data,who were pathologically diagnosed with transitional cell carcinoma,squamous cell carcinoma,adenocarcinoma,clear cell carcinoma and small cell carcinoma.The proportion Cox hazard ratio(HR)was used to examine the clinicopathological variables of patients with various rare pathological types of tumor and UC,and Kaplan-Meier plots was used for further analysis after adjustment with propensity score matching.ResultsWe identified 14517 patients,including 14096 urothelial carcinoma(transitional cell carcinoma),214 squamous cell carcinoma,89 adenocarcinoma,73 clear cell carcinoma and 45 small cell carcinoma.Compared with the patients with UC,patients with squamous cell carcinoma had worse CSS(HR 1.606 95% CI 1.197,2.154,P = 0.02)and OS(HR 1.615,95% CI 1.315,1.984,P < 0.01),which were significantly independent predictors of the prognosis of patients with UTUC.The prognosis of patients with smallcell carcinoma was poor(OS P < 0.01,CSS P < 0.01),but the difference was not significant in multivariate regression analysis.CSS(HR 0.531 95% CI 0.308,0.915,P =0.023)and OS(HR 0.633 95% CI 0.460,0.870,P = 0.005)with better prognosis in patients with clear cell carcinoma,but were not significant in multivariate analysis.There was no significant difference between adenocarcinoma and UC.The benefits of surgical treatment of rare tumors are not the same.Radical nephrectomy plus bladder cuff(RNU)can improve the CSS for patients with squamous cell carcinoma,while for adenocarcinoma,clear cell carcinoma and small cell carcinoma,RNU does not bring them additional benefits,especially for patients with small cell carcinoma,which provides the basis for further chemotherapy.ConclusionThe clinical characteristics and prognosis of different pathological types of upper urinary tract tumors are different,The prognosis of squamous cell carcinoma and small cell carcinoma is poor,while that of clear cell carcinoma is good.There is no significant difference between adenocarcinoma and urothelial carcinoma.Radical nephroureterectomy improves CSS of patients with squamous cell carcinoma,while kidney sparing surgery provides a basis for further chemotherapy of patients with small cell carcinoma.