BACKGROUND: Contemporary incidence and mortality rates of upper tract urothelial carcinoma (UTUC) are unavailable. OBJECTIVE: To describe contemporary UTUC incidence and mortality rates in the USA. DESIGN, SETTING, AND PARTICIPANTS: Within the Surveillance, Epidemiology and End Results (SEER) database (2004-2016), we identified 13 075 UTUC patients. Of all, 9208 (70.4%) harbored nonmetastatic UTUC and were treated with radical nephroureterectomy versus 1174 (9.0%) who harbored metastatic UTUC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Age-standardized incidence rates per 100 000 person years were calculated. Kaplan-Meier curves and multivariable Cox regression models addressed cancer-specific and overall mortality. RESULTS AND LIMITATIONS: Overall UTUC age-standardized incidence rates decreased from 1.3 to 1.1 cases per 100 000 person years (average annual percentage change: -1.32%, p = 0.002). Moreover, age-standardized incidence rates decreased for T1-2N0M0 (average annual percentage change: -2.77%, p < 0.001) but increased for T1-4N0-2M1 stage (average annual percentage change: +2.87%, p < 0.01). In nonmetastatic UTUC treated with radical nephroureterectomy, stage, grade, age, and sex (p < 0.001) were independent predictors in multivariable Cox regression models focusing on cancer-specific mortality. In metastatic UTUC, chemotherapy administration, radical nephroureterectomy treatment, and ureteral primary were independent predictors of lower overall mortality in multivariable Cox regression models. CONCLUSIONS: Although overall incidence of UTUC decreased, the incidence of metastatic UTUC increased over the study period. The majority of nonmetastatic UTUC harbored T1N0M0 stage. However, T3N0M0, T4N0M0, and T1-4N1-2M0 stages, respectively, affected 28.9%, 4.6%, and 10.0% of all incident cases. In metastatic UTUC, both chemotherapy and radical nephroureterectomy use exerted an important protective effect on overall mortality, and ureteral primaries exhibited more favorable survival. PATIENT SUMMARY: From 2004 to 2016, the incidence of upper tract urothelial carcinoma decreased in the USA. However, more advanced stages are on the rise.

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montréal Health Center Montréal Québec Canada

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montréal Health Center Montréal Québec Canada; Department of Neurosciences Reproductive Sciences and Odontostomatology Urology Unit University of Naples Federico 2 Naples Italy

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montréal Health Center Montréal Québec Canada; Department of Urology and Division of Experimental Oncology URI Urological Research Institute IBCAS San Raffaele Scientific Institute Milan Italy

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montréal Health Center Montréal Québec Canada; Department of Urology University Hospital Frankfurt Frankfurt am Main Germany

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montréal Health Center Montréal Québec Canada; Martini Klinik Prostate Cancer Center University Hospital Hamburg Eppendorf Hamburg Germany

Department of Neurosciences Reproductive Sciences and Odontostomatology Urology Unit University of Naples Federico 2 Naples Italy

Department of Neurosciences Reproductive Sciences and Odontostomatology Urology Unit University of Naples Federico 2 Naples Italy; Department of Urology and Division of Experimental Oncology URI Urological Research Institute IBCAS San Raffaele Scientific Institute Milan Italy

Department of Urology and Division of Experimental Oncology URI Urological Research Institute IBCAS San Raffaele Scientific Institute Milan Italy

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria; Department of Urology Weill Cornell Medical College New York NY USA; Department of Urology University of Texas Southwestern Dallas TX USA; Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic; Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia; Division of Urology Department of Special Surgery Jordan University Hospital The University of Jordan Amman Jordan

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