Non-Caucasian Race/Ethnicity Predisposes to Unfavorable Stage and Grade at Upper Tract Urothelial Carcinoma Diagnosis

Francesco Di Bello; Mario de Angelis; Carolin Siech; Natali Rodriguez Peñaranda; Zhe Tian; Jordan A Goyal; Claudia Collà Ruvolo; Gianluigi Califano; Massimiliano Creta; Fred Saad; Shahrokh F Shariat; Alberto Briganti; Felix K H Chun; Salvatore Micali; Nicola Longo; Pierre I Karakiewicz

doi:10.1007/s40615-025-02285-0

Non-Caucasian Race/Ethnicity Predisposes to Unfavorable Stage and Grade at Upper Tract Urothelial Carcinoma Diagnosis

J Racial Ethn Health Disparities. 2025 Jan 9. doi: 10.1007/s40615-025-02285-0. Online ahead of print.

Authors

Francesco Di Bello^{1

2}, Mario de Angelis^{3

4

5}, Carolin Siech^{3

6}, Natali Rodriguez Peñaranda^{3

7}, Zhe Tian³, Jordan A Goyal³, Claudia Collà Ruvolo⁸, Gianluigi Califano⁸, Massimiliano Creta⁸, Fred Saad³, Shahrokh F Shariat^{9

10

11

12}, Alberto Briganti^{4

5}, Felix K H Chun⁶, Salvatore Micali⁷, Nicola Longo⁸, Pierre I Karakiewicz³

Affiliations

¹ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada. fran.dibello12@gmail.com.
² Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Via Pansini, 80131, Naples, Italy. fran.dibello12@gmail.com.
³ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
⁴ Vita-Salute San Raffaele University, Milan, Italy.
⁵ Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁶ Department of Urology, University Hospital, Goethe University Frankfurt, Frankfurt Am Main, Germany.
⁷ Department of Urology, Ospedale Policlinico E Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy.
⁸ Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Via Pansini, 80131, Naples, Italy.
⁹ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
¹⁰ Department of Urology, Weill Cornell Medical College, New York, NY, USA.
¹¹ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹² Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Al-Salt, Amman, Jordan.

PMID: 39789348
DOI: 10.1007/s40615-025-02285-0

Abstract

Objective: To test whether race/ethnicity affects stage or grade distribution at upper tract urothelial carcinoma (UTUC) diagnosis.

Methods: Within the Surveillance, Epidemiology, and End Results (SEER) database 2004-2020, UTUC patients were identified. Multivariable logistic regression models tested for the association between race/ethnicity and stage as well as grade at diagnosis according to renal pelvis vs. ureteral origin. Stage at presentation was defined as (i) metastatic stage (T_anyN_anyM₁) and (ii) advanced stage (locoregional or metastatic (T_3-4N_0-2M_0-1)).

Results: Of 14,384 UTUC patients, 8926 (62%) were renal pelvis. Of renal pelvis UTUC patients, 7064 (79%) were Caucasian, 797 (9%) Hispanic, 623 (7%) Asian Pacific Islander (API), and 442 (5%) African American (AA). Relative to Caucasians, API (odd ratio (OR) 1.85, 95% confidence interval (CI) 1.44-2.37, p < 0.001) and AA (OR 1.37, 95% CI 1.02-1.83, p = 0.03) patients more frequently harbored metastatic stage. APIs also more frequently harbored advanced (OR 1.33, 95% CI 1.11-1.60, p = 0.002) stage and high (OR 1.33, 95% CI 1.07-1.67, p = 0.01) grade. Of 5458 (38%) ureteral UTUC patients, 4360 (80%) were Caucasian, 362 (7%) Hispanic, 509 (9%) API, and 227 (4%) AA. Relative to Caucasians, Hispanic (OR 1.45, 95% CI 1.01-2.05, p = 0.03) patients more frequently harbored metastatic stage. APIs also more frequently harbored advanced stage (OR 1.22, 95% CI 1.02-1.47, p = 0.03) and high (OR 1.94, 95% CI 1.49-2.55, p < 0.001) grade.

Conclusions: Race/ethnicity other than Caucasian, such as API and Hispanic, may predispose to higher odds of metastatic (T_anyN_anyM₁) or advanced (T_3-4N_0-2M_0-1) stages as well as to higher grade at initial diagnosis.

Keywords: Asian; Racial disparities; SEER; Stage-specific; UTUC.