Vol.12, No 2, 2005 pp. 70 - 75
UC 616-006:616.61
MALIGNANT TUMORS OF THE UPPER UROTHELIUM
AND BALKAN ENDEMIC NEPHROPATHY
Stevan Glogovac1, Vidojko Djordjević2, Svetislav Kostić2, Jasmina Tomin3, Nebojša Prokopović1
1Center for Hemodialysis, Leskovac, Serbia and Montenegro
2Institute of Nephrology and Hemodialysis, Niš, Serbia and Montenegro
3Faculty of Medicine, University of Niš, Serbia and Montenegro
 E-mail: glogovacs@bankerinter.net
Summary. One of the most significant features of Balkan endemic nephropathy (BEN) is its association with extremely high frequency of malignant urinary tract tumors noticed even in the first disease description. The aim of the paper is to assess the basic epidemiological characteristics of malignant upper urothelium tumors (MUUT) occurring in Jablanica region in the period of 25 years, and to determine the linear trend of malignant upper urothelium tumors' frequency in regions with BEN compared to non-endemic regions. The research period lasted from 1978 to 2002. During the analysis of the frequency of malignant upper urothelium tumors, we used the operative material of Urology Department, Health Care Center, Leskovac, and Urology Clinic, Clinical Center, Niš. Data on the total number of Jablanica region population were obtained on the basis of the Censuses from 1981 and 1991. The average annual incidence rate (AAIR) was calculated per 100,000 people. The highest AAIR of UUT was registered in endemic settlements (17.56) and the lowest one in non-endemic urban settlements (0.94). Statistically, the linear trend of MUUT in the 25-year-period shows a slow decrease (y  = -0.0054 x + 59; r2 = 0.0031). The results show that malignant upper urothelium tumors (MUUT) in endemic settlements are 3.47 times more frequent than in hypo-endemic ones; 18.68 times more frequent than in non-endemic urban settlements; and 16.88 times more frequent in non-endemic rural settlements. The research on malignant upper urothelium tumors in Jablanica region showed a statistically significant frequency of tumors not only in certain endemic settlements with BEN (Kutles-1 tumor per 99.63 people and AAIR of 40.15) but also in certain non-endemic settlements (Brejanovac -1 tumor per 98.75 people and AAIR 40.50; Rudare 1 tumor per 139.50 people and AAIR 28.67; Bogojevče 1 tumor per 187.63 people and AARI of 21.32). High frequency of malignant upper urothelium tumors in regions with BEN in Jablanica region possibly point to the common nephropathogenic and carcinogenic etiologic factor and confirms the existence of a positive correlation between BEN and malignant tumors of the pyelon and ureter.
Key words: Balkan endemic nephropathy, malignant tumors of the upper urothelium, Jablanica region, type of settlement
MALIGNI TUMORI GORNJEG UROTELIJUMA
I BALKANSKA ENDEMSKA NEFROPATIJA
Kratak sadržaj: Jedna od značajnih osobenosti Balkanske endemske nefropatije (BEN) je činjenica, da je ova bolest udružena sa izrazito visokom učestalošću malignih tumora gornjeg urotelijuma (TuGU) koja je zapažena još u prvom opisu oboljenja. Cilj rada je sagledavanje osnovnih epidemioloških karakteristika tumora gornjeg urotelijuma (Tu GU) Jablaničkog okruga, u periodu od 25 godina i kakav je  linearni trend učestalosti malignih TuGU u regionima sa BEN u odnosu na neendemske regione. Posmatrani period istraživanja je od 1978. god. do 2002. god. Pri proučavanju učestalosti malignih TuGU korišćen je operativni materijal urološkog odeljenja Zdravstvenog centra Leskovac i urološke klinike Kliničkog centra Niš. Podaci o ukupnom broju stanovnika Jablaničckog okruga dobijeni su na osnovu zvaničnih podataka obavljenog popisa stanovništva u 1981. i 1991. god. Prosečna godišnja stopa incidencije (PGSI) je računata na 100 000 stanovnika.  Najveća PGSI TuGU je u endemskim naseljima (17,56) a najmanja u neendemskim gradskim naseljima (0,94). Od ukupnog broja malignih TuGU udruženi tumori se javljaju u 25,30% slučajeva. Od endemskih naselja najveću stopu ima Kutleš (40,15) a od neendemskih Brejanovac (40,50). Linearni trend malignih TuGU za 25-godišnji period je u statistički slabom padu  (y = -0,0054x + 0,59; r2 = 0,0031). Podaci pokazuju u posmatranom  25-godišnjem  periodu, da su maligni TuGU u endemskim naseljima 3,47 češći nego u hipoendemskim; 18,68 češci nego u neendemskim gradskim i 16,88 u neendemskim seoskim naseljima. Istraživanje malignih TuGU Jablaničkog okruga je pokazalo značajnu statističku učestalost tumora samo u nekim endemskim naseljima za BEN (Kutleš - 1 tumor na 99,63 i PGSI 40,15), ali je i učestalost u pojedinim neendemskim naseljima bila vrlo visoka (Brejanovac-1 tumor na 98,75 stanovnika i  PGSI 40,50; Rudare- 1 tumor na 139,50 a PGSI 28,67; Bogojevce-1 tumor na 187,63 a PGSI 21,32). Visoka učestalost  malignih tumora gornjeg urotelijuma u regionima sa BEN Jablaničkog okruga, možda ukazuje na zajednički nefropatogeni i kancerogeni etiološki faktor i potvrdjuje postojanje pozitivne korelacije izmedu BEN i malignih tumora pijelona i uretera.
Ključne reči: Balkanska endemska nefropatija, maligni tumori gornjeg urotelijuma, Jablanički region, tip naselja