Apoptosis and p53 status of the upper urothelial carcinomas from Balkan endemic nephropathy regions.

The upper urothelial carcinomas (UUC) associated with endemic nephropathy and analgesic nephropathy are considerably similar in many characteristics. These similarities diversify them from the same carcinomas in the general population w1x. Bilateral occurrence (simultaneous or successive) of the UUC is observed in about 8% cases of analgesic nephropathy and 10–14% in endemic Balkan nephropathy. Multiple occurrence is seen in up to one-third of cases, with every 15th patient developing cancer in the urinary bladder. By regular examinations for UUC during several years on haemodialysis, the tumour prevalence increased to 16 against 1 in endemic or analgesic nephropathy and remained 1 against 50 in patients with other kidney diseases. The maximum incidence of UUC in endemic regions is in the sixth to seventh decades of life. Those UUC slowly expand with rare metastases outside endemic regions; the median time of the UUC growth following clinical presentation is two times shorter. An epidemiological survey of the group of nephrectomized patients at the Clinic of Urology of Belgrade revealed a better survival of UUC patients from endemic regions, 8 against 3 years on average w2x. The impression of a slow evolutionary process contrasts with the presence of advanced tumour malignancy grade II and III. Routine histologic examination did not reveal any significant differences in characteristics of the UUC in relation to the settlement in large groups of patients during several decades.