Sex- and Age-Related Differences in the Distribution of Metastases in Patients With Upper Urinary Tract Urothelial Carcinoma

Authors:
Marina Deuker Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada;
Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;

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Giuseppe Rosiello Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada;
Department of Urology and Division of Experimental Oncology, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy;

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Lara Franziska Stolzenbach Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada;
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;

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Thomas Martin Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada;

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Claudia Collà Ruvolo Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada;
Department of Urology, University of Naples Federico II, Naples, Italy;

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Luigi Nocera Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada;
Department of Urology and Division of Experimental Oncology, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy;

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Zhe Tian Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada;

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Frederik C. Roos Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;

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Andreas Becker Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;

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Luis A. Kluth Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;

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Derya Tilki Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;

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Shahrokh F. Shariat Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;
Institute of Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; and
Department of Urology, University of Jordan, Amman, Jordan.

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Fred Saad Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada;

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Felix K.H. Chun Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;

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Pierre I. Karakiewicz Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada;

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Background: The distribution of metastatic sites in upper tract urothelial carcinoma (UTUC) is not well-known. Consequently, the effects of sex and age on the location of metastases is also unknown. This study sought to investigate age- and sex-related differences in the distribution of metastases in patients with UTUC. Materials and Methods: Within the Nationwide Inpatient Sample database (2000–2015), we identified 1,340 patients with metastatic UTUC. Sites of metastasis were assessed according to age (≤63, 64–72, 73–79, and ≥80 years) and sex. Comparison was performed with trend and chi-square tests. Results: Of 1,340 patients with metastatic UTUC, 790 (59.0%) were men (median age, 71 years) and 550 (41.0%) were women (median age, 74 years). The lung was the most common site of metastases in men and women (28.2% and 26.4%, respectively), followed by bone in men (22.3% vs 18.0% of women) and liver in women (24.4% vs 20.5% of men). Increasing age was associated with decreasing rates of brain metastasis in men (from 6.5% to 2.9%; P=.03) and women (from 5.9% to 0.7%; P=.01). Moreover, increasing age in women, but not in men, was associated with decreasing rates of lung (from 33.3% to 24.3%; P=.02), lymph node (from 28.9% to 15.8%; P=.01), and bone metastases (from 22.2% to 10.5%; P=.02). Finally, rates of metastases in multiple organs did not vary with age or sex (65.2% in men vs 66.5% in women). Conclusions: Lung, bone, and liver metastases are the most common metastatic sites in both sexes. However, the distribution of metastases varies according to sex and age. These observations apply to everyday clinical practice and may be used, for example, to advocate for universal bone imaging in patients with UTUC. Moreover, our findings may also be used for design considerations of randomized trials.

Submitted March 6, 2020; accepted for publication August 9, 2020. Published online February 11, 2021.

Author contributions: Study concept and design: Deuker, Stolzenbach, Collà Ruvolo, Nocera, Martin, Tian, Karakiewicz. Data acquisition: Tian, Karakiewicz. Quality control of data and algorithms: Deuker, Tian. Data analysis and interpretation: Deuker, Stolzenbach, Collà Ruvolo, Nocera, Martin, Tian. Statistical analysis: Deuker, Tian. Manuscript preparation: Deuker, Stolzenbach, Collà Ruvolo, Nocera, Martin. Manuscript editing: Roos, Becker, Kluth, Tilki, Shariat, Saad, Chun, Karakiewicz. Manuscript review: Chun, Karakiewicz.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Marina Deuker, MD, Department of Urology, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany. Email: marina.deuker@kgu.de

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