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

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.