Urological Oncology: Adrenal, Renal, Ureteral and Retroperitoneal Tumors Re: Regional Differences in Practice Patterns and Associated Outcomes for Upper Tract Urothelial Carcinoma in Canada

Editorial Comment: The rarity of upper tract urothelial cancer has been one of the main reasons why in the last several years different treatment centers have been joining forces to form collaborative groups. These groups retrospectively assess epidemiological and practice patterns, and outcomes. One example is described in this Canadian report of demographic, clinical and pathological variables in patients undergoing nephroureterectomy at 10 centers across 3 regions between 1994 and 2009. The presence of significant differences among regions in clinical, surgical and pathological characteristics illustrates the lack of standardization of management and the profound variations in clinical practice related to UTUC. Clinical and pathological differences may reflect socioeconomic variations, delay in referral practices, previous endoscopic management or the presence of disease clusters. Surgical differences reflect availability of technology, and lack of data regarding type of nephrectomy and management of the distal ureter. Although these differences did not affect oncologic outcomes and pathological findings remained the most important predictor of oncologic outcomes, a call for standardization and clinical recommendations is in order at least until the impact of diagnostic and treatment delay on ultimate outcomes can be determined.