Abstract
ABSTRACTObjectives:The objective of this study was to update the long-term outcome in the treatment of locally advanced upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU) regarding the role of adjuvant chemotherapy.Materials and methods:Clinical data from 138 patients who underwent RNU for locally advanced UTUC (pT3/4 or pN+) were analyzed.Results:The adjuvant chemotherapy group comprised 66 patients, and other 72 patients did not receive adjuvant chemotherapy. Cisplatin-based chemotherapy was the most common regimen, depending on the patient's eligibility and renal function. The median follow-up period was 48.7 months (interquartile range: 29.2-96.9 months). The 3-and 5-year disease-specific survival (DSS) rates were 76.0% and 69.9% for the non-adjuvant chemotherapy group versus 74.6% and 54.5% for the adjuvant chemotherapy group (p=0.301, log-rank test). Overall survival (OS) rates for the same time period were 70.1% and 62.9% for the non-adjuvant chemotherapy group versus 73.8% and 53.2% for the adjuvant chemotherapy group (p=0.931, log-rank test). On multivariate analysis, adjuvant chemotherapy could not predict DSS and OS after surgery. When patients who received cisplatin-based adjuvant chemotherapy (n=59) were compared to those who did not receive adjuvant chemotherapy, similar results were found.Conclusions:There does not appear to be a significant DSS or OS benefit associated with adjuvant chemotherapy. Prospective randomized clinical trials are necessary to verify the effect of adjuvant chemotherapy on locally advanced UTUC.
Highlights
Upper tract urothelial carcinoma (UTUC) is a rare disease that accounts for approximately 5% of all urothelial malignancies [1]
Table-1 compares the characteristics of patients who did not receive adjuvant chemotherapy (n=72) and those who received adjuvant chemotherapy (n=66) or cisplatin-based adjuvant chemotherapy (n=59)
For UTUC, adjuvant chemotherapy provided a therapeutic benefit in some studies [6, 11, 12], while there was no significant difference in outcomes between adjuvant and non-adjuvant chemotherapy groups in others [13,14,15,16,17,18]
Summary
Upper tract urothelial carcinoma (UTUC) is a rare disease that accounts for approximately 5% of all urothelial malignancies [1]. Radical nephroureterectomy (RNU) has been considered standard care for treating localized UTUC, 45-60% of patients with locally advanced disease will relapse after extirpative surgery alone [2]. Contemporary analyses indicate that there has been no improvement in survival rates in the past several decades for patients with high-grade disease [4]. Ibju | Adjuvant chemotherapy for upper tract urothelial cancer. Adjuvant chemotherapy with agents for metastatic disease may be reasonable in treating locally advanced UTUC associated with poor survival. There is no standardized therapy conferring a survival benefit after RNU, as there have been no controlled trials that explored the efficacy of adjuvant chemotherapy in this setting. Most evidence for the treatment of patients with UTUC may be extrapolated from experience with bladder cancer
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