The Influence of Age on Cancer-Specific and Other-Cause Mortality in Upper Tract Urothelial Carcinoma

Background: Upper tract urothelial carcinoma (UTUC) is a rare malignancy with prognosis predicated on clinical and pathological factors. Radical nephroureterectomy is the standard treatment for higher risk localized UTUC, although competing mortality may influence optimal treatment selection in older patients. Methods: A retrospective population-based cohort study was conducted using the Surveillance, Epidemiology, and End Results program. Individuals diagnosed with UTUC of the renal pelvis or ureter between 2000 and 2017 were included. Patients with unknown tumor grade or size were excluded. Results: A total of 10,894 patients were included. During a median follow-up of 26 months, 57% died from any cause and 27% died from UTUC. For each 5-year increase in age of diagnosis, the cancer-specific mortality risk rises more in low-grade patients (21% increased riskjtp: 0.008) than high-grade patients (9% increased risk p: 0.023). Other-cause mortality risk rose markedly with increasing age (SHR 3.54 for ages 85+, p < 0.001). Conclusions: Age at diagnosis is significantly associated with cancer-specific mortality in UTUC. Incorporating age and competing risk into risk stratification may help inform shared decision-making regarding treatment approaches in older patients.