Abstract
The clinical efficacy of adjuvant chemotherapy in upper tract urothelial carcinoma (UTUC) is unclear. We aimed to assess the therapeutic outcomes of adjuvant chemotherapy in patients with advanced UTUC (pT3-T4) after radical nephroureterectomy (RNU). We retrospectively reviewed the data of 2108 patients from the Taiwan UTUC Collaboration Group between 1988 and 2018. Comprehensive clinical features, pathological characteristics, and survival outcomes were recorded. Univariate and multivariate Cox proportional hazards models were used to evaluate overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Of the 533 patients with advanced UTUC included, 161 (30.2%) received adjuvant chemotherapy. In the multivariate analysis, adjuvant chemotherapy was significantly associated with a reduced risk of overall death (hazard ratio (HR), 0.599; 95% confidence interval (CI), 0.419–0.857; p = 0.005), cancer-specific mortality (HR, 0.598; 95% CI, 0.391–0.914; p = 0.018), and cancer recurrence (HR, 0.456; 95% CI, 0.310–0.673; p < 0.001). The Kaplan–Meier survival analysis revealed that patients receiving adjuvant chemotherapy had significantly better five-year OS (64% vs. 50%, p = 0.002), CSS (70% vs. 62%, p = 0.043), and DFS (60% vs. 48%, p = 0.002) rates compared to those who did not receive adjuvant chemotherapy. In conclusion, adjuvant chemotherapy after RNU had significant therapeutic benefits on OS, CSS, and DFS in advanced UTUC.
Highlights
Upper tract urothelial carcinoma (UTUC) is a relatively rare tumor that accounts for10% of all renal tumors and 5% of urothelial malignancies overall, with an estimated annual incidence of almost two cases per 100,000 inhabitants in Western countries [1,2]
This study observed 533 patients diagnosed with advanced upper tract urothelial carcinoma (UTUC) after standard treatment with RUN
We found that adjuvant chemotherapy, tumor size, tumor grade, multiplicity of the tumor, and pathological stage, including T and N stage, were significantly associated with overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS)
Summary
Upper tract urothelial carcinoma (UTUC) is a relatively rare tumor that accounts for. 10% of all renal tumors and 5% of urothelial malignancies overall, with an estimated annual incidence of almost two cases per 100,000 inhabitants in Western countries [1,2]. In Taiwan, the incidence rate of UTUC is much higher than that worldwide and in Western populations, and the prevalence of UTUC is as high as 30% of all urothelial carcinomas (UCs) [3,4,5]. Radical nephroureterectomy (RNU) with bladder cuff excision is regarded as the standard therapy for local UTUC, but monotherapy with surgical intervention is considered to be associated with relatively high recurrence rates and low survival rates in the advanced pathological stage [2,4,5,8]. The five-year overall survival rate is less than 50% in patients with T2–3 and less than 10% in patients with
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