Effects of Socioeconomic Deprivation on UTUC Staging, Mortality, and Recurrence

Abstract

Objective

To determine whether the area deprivation index (ADI), a surrogate for socioeconomic status (SES) associated with patient residence, affected UTUC staging, recurrence rates, and mortality.

Methods

Patients undergoing radical nephroureterectomy or ureterectomy for UTUC at a single institution between February 2010 and August 2021 were classified by ADI. A 50th percentile cut-off of ADI classified patients as “advantaged” or “disadvantaged. Tumor characteristics, staging, and use of neoadjuvant chemotherapy were compared between groups. Recurrence-free (RFS) and overall survival (OS) were compared among groups using Mantel-Cox log-rank testing.

Results

In this cohort, 215 patients had advantaged SES, and 217 had disadvantaged SES. Neoadjuvant chemotherapy was utilized more frequently among advantaged versus disadvantaged patients (20% vs 13%, P = .035), though this difference was not significant when comparing the most advantaged and least advantaged quartiles (18% vs 14%, P = .45). No significant difference was observed in positive resection margins between groups (11% vs 13%, P = .53). Tumor characteristics, including median tumor size (P = .15), pathologic tumor stage (P = .81), and pathologic lymph node stage (P = .28), were also similar. There were no differences in median RFS or OS between SES groups.

Conclusion

This regional data, considering previous studies suggesting worse outcomes with increased urothelial carcinoma incidence and mortality in those with a lower socioeconomic status, may reflect efforts to improve healthcare access and adhere to evidence-based management patterns.