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ORIGINAL ARTICLES
NUMBER 1 YEAR 2003
Recent Data on the Epidemiology of Urothelial Tumors in our Region
1 Department of Urology
Victor Babes University of Medicine and Pharmacy

Correspondence to:
Radu Minciu, MD
Bd. L. Rebreanu 156, 1900 Timisoara, Phone: +40-256-163-001/ext. 392
Fax: +40-256-306-116; E-mail: rminciu@hosptm.ro
ABSTRACT
Overall incidence of neoplasies in our region significantly increased after the Chernobyl nuclear accident. The aim of our study was to compare epidemiological changes of urothelial tumors from 1990-1999 with those from 1971-1982 and to observe whether significant changes had occured. The results of our study suggest that there are no significant changes in epidemiological patterns of urothelial tumors between the two periods.
INTRODUCTION

Urothelial tumors represent 5 to 10% of all renal tumors. Their epidemiological pattern showed a significantly increasing incidence during the last years.1-3 Most of them occur in the latter part of adulthood but they were also observed in young people. They appear to be two times more frequent in males living in urban areas.4-6
Since the nuclear accident from Chernobyl, in 1986, a significant increase in the incidence of neoplastic diseases has been observed. Hence, the aim of this study is to assess whether the incidence of urothelial tumors and its epidemiological patterns have changed during the last decade by comparing cases admitted in our Clinic in two distinct periods of time: 1971-1982 and 1990-1999.

MATERIAL AND METHODS

The charts of 110 patients admitted in our clinic between 1990 and 1999 with urothelial tumors were retrospectively analyzed and compared with those of 80 patients admitted between 1971-1982, with respect to the following data: age, gender, geographical distribution and tumor localization. The vast majority of patients were over 60 years, few of them being under the age of 29. Figure 1.

RESULTS

The incidence of the tumors has increased from 6.6 to 11 cases/year in the second period.
As shown above, 68% of patients were aged between 60 and 79 years. The explanation for a reduced number of tumors occurring in patients over 80 years could be life expectancy (70 years for Romania nowadays) rather than a real decrease of the tumor incidence in ageing people. Cases of tumors in young adults (under the age of 30) are rarely found.
People aged 60-69 are most frequently affected in both studies: 37.5% - 38.1%. In the previous study the group aged 50-69 years included 71% of cases, while in the recent study practically the same percentage affected the group aged 60-79 years.5 Despite the expected decrease in the patient’s a slowly increasing age was observed.
In the literature, male /female ratio is 2.3/1.1,2,6 In the second study group, 58 patients were males and 52 females (male /female ratio = 1.11), while in the first (1983) this ratio was 1.10 (42/38). Male/female ratio and patient’s age are illustrated in Figure 2.
As shown above, in the 6-th decade males are 8 times more frequently affected by disease, possible by prolonged exposure of active men to risk factors.
The ratio remains supra unitary for groups 30-50 years (2 and 1.66) and becomes sub unitary for patients older than 60 years - 0.9 and 0.65 respectively. Figure 3.
Concerning geographical distribution, 50% of patients of the second study group came from Timis County. Interesting is that Mehedinti County (with 20% of cases) is very well represented compared with the other counties (5-8% each), being included in the Balkan Endemic Nephropathy area, that has been demonstrated to be a risk factor for urothelial tumors.6 Figure 4.
Balkan Endemic Nephropathy area, that has been demonstrated to be a risk factor for urothelial tumors.6 Figure 5.
Table 1 . Distribution of urothelial tumors by age.
Table 2. Age and gender distribution.

Figure 3. Age and gender distribution of patients.
Figure 4. Geographical distribution of urothelial tumors.

Figure 5. Localization of urothelial tumors.
 
In the first study group, 33.75% of patients came from Timis and 31.25% from Mehedinti. Lower percent of patients coming from Mehedinti (and Balkan Endemic Nephropathy area) could be explained by increasing activity of two other urological departments closer to this county (Craiova and Drobeta Turnu Severin).
In the second group, the patients coming from urban area are preponderant (urban/rural ratio = 1.9), higher than in the first group (1.3), possible due to decreasing number of patients coming from Balkan Endemic Nephropathy area as most of those coming from that particular region are from rural areas.5
Urothelial tumors can be located anywhere in upper urinary tract as a single or multiple tumors.2,4
Single tumors are most common: pelvic (32.73%), ureteral (31.82%) or (rarely) calyceal (10.91%).
Multiple tumors, pelvic and ureteral (18.18%), are more frequent than in other studies.3,4

CONCLUSIONS

• In the last decade the incidence of urothelial tumors has not increased as fast as that of other neoplastic disorders.
• The most frequent cases occur in males, aged 50 to 79 years, living in urban areas.
• Cases coming from Balkan Endemic Nephropathy area still represent a large percent (20%).
• Single tumors are more frequent.
• Epidemiological patterns of urothelial tumors from the last decade seem to respect those of the 1971-1982 period.
REFERENCES

1. Carroll PR. Urothelial carcinoma: Cancers of the bladder, ureter & renal pelvis, In: Smith’s General Urology, Tanagho EA, McAninch JW, 1995
2. Charbit L, Gendreau M, Mee S, Cukier J. Tumors of the
upper urinary tract: 10 years of experience. J Urol 1991; 146: 1243-46.
3. Deligne E, Colombel M, Badet L, Taniere P, Rouviere O, Dubernard JM, Lezrek M, Gelet A, Martin X. Conservative management of upper urinary tract tumors. Eur Urol 2002; 42: 43-8.
4. Mazeman E. Tumors of the urinary tract (calyces, renal pelvis and ureter):1118 cases. Eur Urol 1976; 2: 120-9.
5. Minciu R. Contribution on the study of the morbidity and treatment of pelvic and ureteral urothelial tumors, University Graduation Thesis, Timisoara 1983.
6. Petkovic S, Mutavdzic M, Petronic V L, Markovic V. Tumors of renal pelvis and ureter: Clinical and etiologic studies. J Urol Nephrol 1971; 429-33.



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