{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:36:41Z","timestamp":1787027801784,"version":"build-2736575974"},"reference-count":28,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Urothelial carcinoma is the second most common urological cancer, mainly affecting the bladder (90\u201395% of cases) while primary Upper Urinary Tract Urothelial Carcinomas (UTUC) are rare (5\u201310%). Socioeconomic and gender differences are known in urological cancers like urothelial carcinoma of the bladder, often based on national indices rating cities as single units. This study investigated factors influencing survival in patients with primary UTUC within Hamburg, Germany. Methods: We conducted a retrospective population-based cohort study using data extracted from the Hamburg cancer registry for all primary UTUC cases diagnosed between January 2004 and June 2021. Patient and tumor characteristics, socioeconomic status (measured by a neighborhood-level deprivation index), treatment patterns, and survival outcomes were analyzed. Kaplan\u2013Meier analyses estimated survival probabilities, and a Cox Proportional Hazard Model with and without time transformation assessed survival factors. Results: The cohort included 727 patients (median age 74, 42.2% female), with a median follow-up of 2.2 years (IQR: 0.8\u20135.5 years). Relevant survival predictors were age, sex, and cancer stage. Older age was associated with reduced excess mortality risk (HR = 0.974), while female sex (HR = 1.472) and advanced stage (HR = 3.343) were associated with higher excess mortality risk. Socioeconomic status and diagnosis period had no measurable impact. Conclusions: Yet, a small sample size and single registry data may limit the generalizability of these results. Further research with larger cohorts is needed.<\/jats:p>","DOI":"10.3390\/cancers17172724","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T11:50:31Z","timestamp":1755863431000},"page":"2724","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Impact of Patient, Tumor, and Socioeconomic Characteristics on Survival in Upper Urinary Tract Urothelial Carcinoma (UTUC): A Population-Based Registry Study from Hamburg, Germany (2004\u20132021)"],"prefix":"10.3390","volume":"17","author":[{"given":"Annemarie","family":"Schultz","sequence":"first","affiliation":[{"name":"Hamburg Cancer Registry, 20097 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"Jobst","sequence":"additional","affiliation":[{"name":"Hamburg Cancer Registry, 20097 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik","family":"Peters","sequence":"additional","affiliation":[{"name":"Hamburg Cancer Registry, 20097 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Netsch","sequence":"additional","affiliation":[{"name":"Department of Urology, Asklepios Hospital Barmbek, 22307 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens M.","family":"Rosenbaum","sequence":"additional","affiliation":[{"name":"Department of Urology, Asklepios Hospital Barmbek, 22307 Hamburg, Germany"},{"name":"Department of Urology, University Hospital Schleswig-Holstein, 23562 L\u00fcbeck, Germany"},{"name":"Department of Urology, Asklepios Paulinen Hospital, 65197 Wiesbaden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Filmar","sequence":"additional","affiliation":[{"name":"Department of Urology, Asklepios Hospital Barmbek, 22307 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Jansen, L., Behrens, G., Finke, I., Maier, W., Gerken, M., Pritzkuleit, R., Holleczek, B., and Brenner, H. (2020). German Cancer Survival Working Group Area-Based Socioeconomic Inequalities in Colorectal Cancer Survival in Germany: Investigation Based on Population-Based Clinical Cancer Registration. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.00857"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1111\/j.1349-7006.2006.00179.x","article-title":"Cervical and Corpus Cancer Survival Disparities by Socioeconomic Status in a Metropolitan Area of Japan","volume":"97","author":"Ueda","year":"2006","journal-title":"Cancer Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1093\/annonc\/mdj007","article-title":"Origins of Socio-Economic Inequalities in Cancer Survival: A Review","volume":"17","author":"Woods","year":"2006","journal-title":"Ann. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1111\/j.1464-410X.2012.11661.x","article-title":"Do Differences in Clinical Symptoms and Referral Patterns Contribute to the Gender Gap in Bladder Cancer?","volume":"112","author":"Henning","year":"2013","journal-title":"BJU Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S62","DOI":"10.1055\/a-1009-6466","article-title":"Data from Population-Based Cancer Registration for Secondary Data Analysis: Methodological Challenges and Perspectives","volume":"82","author":"Arndt","year":"2020","journal-title":"Gesundheitswesen"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.eururo.2023.03.013","article-title":"European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2023 Update","volume":"84","author":"Seisen","year":"2023","journal-title":"Eur. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1111\/bju.15389","article-title":"Rising Incidence Rates and Unaltered Survival Rates for Primary Upper Urinary Tract Urothelial Carcinoma: A Dutch Population-Based Study from 1993 to 2017","volume":"128","author":"Boormans","year":"2021","journal-title":"BJU Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1002\/jso.25877","article-title":"Contemporary Conditional Cancer-Specific Survival After Radical Nephroureterectomy in Patients with Nonmetastatic Urothelial Carcinoma of Upper Urinary Tract","volume":"121","author":"Rosiello","year":"2020","journal-title":"J. Surg. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.kjms.2012.08.006","article-title":"The Association Between Gender and Outcome of Patients with Upper Tract Urothelial Cancer","volume":"29","author":"Chou","year":"2013","journal-title":"Kaohsiung J. Med. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1016\/j.juro.2014.04.101","article-title":"Gender Disparities in Hematuria Evaluation and Bladder Cancer Diagnosis: A Population Based Analysis","volume":"192","author":"Garg","year":"2014","journal-title":"J. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.urology.2020.05.067","article-title":"Gender Differences in Incidence, Diagnosis, Treatments, and Outcomes in Clinically Localized Bladder and Renal Cancer","volume":"151","author":"Gul","year":"2021","journal-title":"Urology"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Huang, C.-C., Su, Y.-L., Luo, H.-L., Chen, Y.-T., Sio, T.T., Hsu, H.-C., and Lai, C.-H. (2019). Gender Is a Significant Prognostic Factor for Upper Tract Urothelial Carcinoma: A Large Hospital-Based Cancer Registry Study in an Endemic Area. Front. Oncol., 9.","DOI":"10.3389\/fonc.2019.00157"},{"key":"ref_13","first-page":"189","article-title":"The cancer registry notification seen from the perspective of the German Society of Uro-Oncologists (d-uo)","volume":"54","author":"Doehn","year":"2023","journal-title":"Aktuelle Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1007\/s00345-024-04888-4","article-title":"The Influence of Socioeconomic Status and Gender on Incidence and Survival in Bladder Cancer: A Longitudinal Study Based on the Hamburg Cancer Registry","volume":"42","author":"Rosenbaum","year":"2024","journal-title":"World J. Urol."},{"key":"ref_15","unstructured":"Bev\u00f6lkerung in Hamburg 2020. Statistik Nord. Available online: https:\/\/www.statistik-nord.de\/zahlen-fakten\/bevoelkerung\/bevoelkerungsstand-und-entwicklung\/dokumentenansicht\/bevoelkerung-in-hamburg-2020-63065."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1037\/0003-066X.49.1.15","article-title":"Socioeconomic Status and Health. The Challenge of the Gradient","volume":"49","author":"Adler","year":"1994","journal-title":"Am. Psychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/j.ejca.2008.11.032","article-title":"Evaluation of Data Quality in the Cancer Registry: Principles and Methods. Part I: Comparability, Validity and Timeliness","volume":"45","author":"Bray","year":"2009","journal-title":"Eur. J. Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Anders, A.I.M.A. (2016). Einschr\u00e4nkungen. Selbstreferenz, Springer.","DOI":"10.1007\/978-3-658-11709-2"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1093\/biostatistics\/kxn021","article-title":"An Approach to Estimation in Relative Survival Regression","volume":"10","author":"Perme","year":"2009","journal-title":"Biostatistics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1016\/j.urolonc.2011.09.011","article-title":"Gender-Specific Differences in Cancer-Specific Survival After Radical Cystectomy for Patients with Urothelial Carcinoma of the Urinary Bladder in Pathologic Tumor Stage T4a","volume":"31","author":"May","year":"2013","journal-title":"Urol. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.acuro.2021.09.012","article-title":"Prognostic Significance of Age, Sex, Race, and Socioeconomic Status in Patients with Stage III\u2013IV Upper Tract Urothelial Carcinoma","volume":"46","author":"Zhou","year":"2022","journal-title":"Actas Urol. Esp."},{"key":"ref_23","first-page":"162.e1","article-title":"Regional Differences in Upper Tract Urothelial Carcinoma Patients Across the United States","volume":"42","author":"Morra","year":"2024","journal-title":"Urol. Oncol. Semin. Orig. Investig."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.urolonc.2011.08.011","article-title":"Disparities in Bladder Cancer","volume":"30","author":"Jacobs","year":"2012","journal-title":"Urol. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"668","DOI":"10.21037\/tau.2016.03.22","article-title":"Female with Bladder Cancer: What and Why Is There a Difference?","volume":"5","author":"Marks","year":"2016","journal-title":"Transl. Androl. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"534","DOI":"10.6004\/jnccn.2020.7637","article-title":"Sex- and Age-Related Differences in the Distribution of Metastases in Patients with Upper Urinary Tract Urothelial Carcinoma","volume":"19","author":"Deuker","year":"2021","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2182","DOI":"10.1016\/j.jfma.2022.03.012","article-title":"Prognostic Value of Renal Function for Upper Tract Urothelial Carcinoma Who Underwent Radical Nephroureterectomy: Sex Differences","volume":"121","author":"Chien","year":"2022","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1111\/j.1464-410X.2004.04997.x","article-title":"West Midlands Urological Research Group Socio-Economic Deprivation and Survival in Bladder Cancer","volume":"94","author":"Begum","year":"2004","journal-title":"BJU Int."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/17\/2724\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:33:39Z","timestamp":1760034819000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/17\/2724"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,22]]},"references-count":28,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["cancers17172724"],"URL":"https:\/\/doi.org\/10.3390\/cancers17172724","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,22]]}}}