Epidemiology, diagnosis, and treatment trends of surgically managed upper tract urothelial carcinoma in Taiwan, 1988–2022: A retrospective multicenter registry study

Purpose: To analyze epidemiological data and treatment trends for upper-tract urothelial carcinoma (UTUC) in Taiwan over a 30-year period (1988–2022). Materials and methods: This retrospective, multi-institutional study conducted by the Taiwan Upper-Tract Urothelial Carcinoma Collaboration Group analyzed clinical data between 1988 and 2022 across 19 hospitals. Variables included demographics, comorbidities, risk factors, renal function, tumor characteristics, diagnostic methods, surgical approaches, chemotherapy status, pathological features, and oncological outcomes. Results: In Taiwan, UTUC showed a female predominance (56.8% women vs 43.2% men; female-to-male ratio 1.3:1), and the overall mean age was 68.7 years. Chronic kidney disease and end-stage renal disease were present in 63% and 16.7% of patients, respectively. Nephroureterectomy was performed in 88% of patients, with nearly 60% of these procedures employing either robotic-assisted or pure laparoscopy techniques during the past 5 years. Chemotherapy was administered in 25.2% of cases, including 2.4% receiving neoadjuvant chemotherapy and 15.6% receiving adjuvant chemotherapy. Postoperative intravesical chemotherapy instillation was performed in 5.3% of cases. Pathological T stages included pT1 or lower (38.8%), pT2 (17.0%), pT3 (25.5%), and pT4 (8.3%). Carcinoma in situ was present in 20.1% of cases, lymphovascular invasion in 16.8%, and positive surgical margins in 4.1%. Major postoperative complications occurred in 4.6% of cases, while 1% of patients experienced grade V complications. Conclusion: Our study demonstrates that Taiwan’s treatment outcomes for UTUC are comparable to those reported internationally, reflecting its proficiency in adopting advanced technologies and maintaining high standards of medical care. However, unique epidemiological factors, such as a higher prevalence of end-stage renal disease, pose challenges to treatment implementation, particularly in the use of nephrotoxic regimens like neoadjuvant chemotherapy.