Metastatic Distribution of Urothelial Cancer: Differences Related to Age and Sex
Posted: Thursday, April 22, 2021
Understanding the distribution and potential sex- and age-specific differences in metastatic urinary tract urothelial carcinoma is essential for clinicians. Pierre I. Karakiewicz, MD, of the University of Montreal Health Center, Canada, and colleagues hypothesized that this metastatic distribution differs according to sex and age—although with no statistical significance. Published in JNCCN–Journal of the Comprehensive Cancer Network, their research may support universal bone imaging for this patient population.
The investigators focused on 1,340 adult patients from the Nationwide Inpatient Sample database who were diagnosed with metastatic urinary tract urothelial carcinoma. Of the total population, 790 were men and 550 were women. Variables included age quartiles (up to 63, 64–72, 73–79, and 80 and older), location of metastasis (abdominal, thoracic, brain, or bone), and the number of metastatic sites at diagnosis (one vs. two or more).
The primary location of urinary tract urothelial carcinoma in the ureter versus the renal pelvis was not significantly different between men and women, yet there was a statistically significant difference with respect to age at diagnosis (71 vs. 74 years). In both sexes, metastases in the lungs were the most common. Statistical significance was not reached for any difference in sex-related metastasis. As age increased, the rate of brain metastasis decreased for both sexes. For women, rates of metastases decreased in the lungs (from 33.3% to 24.3%), lymph nodes (from 28.9% to 15.8%), and bone (from 22.2% to 10.5%) with increasing age. There were no other metastases that showed significant changes in the rates based on age.
A majority of patients had more than two metastatic sites. The rate of liver metastasis was the only statistically significant increase of exclusive liver metastases in women with increasing age. Brain metastases occurred in 3.6% of all patients, most of whom were notably younger than those with metastases at other sites. In individuals with either thoracic or abdominal metastases, brain metastases were found in 7.9% and less than 2% of patients, respectively.
Disclosure: The study authors reported no conflicts of interest.