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BioMed Research International
Volume 2014, Article ID 149750, 9 pages
Research Article

Increased Upper and Lower Tract Urothelial Carcinoma in Patients with End-Stage Renal Disease: A Nationwide Cohort Study in Taiwan during 1997–2008

1Department of Urology, National Taiwan University Hospital, Taipei 10002, Taiwan
2Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei 10020, Taiwan
3Department of Statistics, Feng Chia University, Taichung 40724, Taiwan
4Chang Gung Memorial Hospital, Taipei 10507, Taiwan
5Institute of Statistical Science, Academia Sinica, Taipei 11529, Taiwan
6Department of Public Health, National Cheng Kung University Medical College, Tainan City 70101, Taiwan
7Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan City 70403, Taiwan

Received 23 February 2014; Accepted 15 May 2014; Published 16 June 2014

Academic Editor: Li-Jen Wang

Copyright © 2014 Shuo-Meng Wang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Urothelial cancer (UC) is the leading cancer of patients with end-stage renal disease (ESRD) in Taiwan. The aims of this study were to explore the time trends of UC incidences and propose possible etiologic factors. Methods. Abstracting from the National Health Insurance Research Database (NHIRD), there were 90,477 newly diagnosed cases of ESRD between 1997 and 2008 covering the patients aged 40–85. Among them, 2,708 had developed UC after diagnosis of ESRD. The CIR40–85 (cumulative incidence rate) of upper tract UC (UTUC) and lower tract UC (LTUC) were calculated for ESRD patients and general population, as well as SIR40–85 (standardized incidence ratio) for comparison. Results. Female ESRD patients were found to have 9–18 times of elevated risks of UC, while those of males were increased up to 4–14 times. The time trends of CIR40–84 and SIR40–84 of UTUC in females appear to decline after calendar year 2000. These trends may be related to AA associated herbal products after 1998. Conclusions. Patients with ESRD are at increased risks for both LTUC and UTUC in Taiwan. We hypothesize that the time trends associate with the consumption of aristolochic acid in Chinese herbal products (female predominant).