MP71-09 EFFECTIVENESS OF ADJUVANT CHEMOTHERAPY AFTER RADICAL NEPHROURETERECTOMY FOR LOCALLY ADVANCED AND/OR POSITIVE REGIONAL LYMPH NODE UPPER TRACT UROTHELIAL CARCINOMA

Abstract

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I1 Apr 2017MP71-09 EFFECTIVENESS OF ADJUVANT CHEMOTHERAPY AFTER RADICAL NEPHROURETERECTOMY FOR LOCALLY ADVANCED AND/OR POSITIVE REGIONAL LYMPH NODE UPPER TRACT UROTHELIAL CARCINOMA Thomas Seisen, Ross E. Krasnow, Joaquim Bellmunt, Morgan Rouprêt, Jeffrey J. Leow, Stuart R. Lipsitz, Malte Vetterlein, Mark A. Preston, Nawar Hanna, Adam S. Kibel, Maxine Sun, Toni K. Choueiri, Quoc-Dien Trinh, and Steven Lee Chang Thomas SeisenThomas Seisen More articles by this author , Ross E. KrasnowRoss E. Krasnow More articles by this author , Joaquim BellmuntJoaquim Bellmunt More articles by this author , Morgan RouprêtMorgan Rouprêt More articles by this author , Jeffrey J. LeowJeffrey J. Leow More articles by this author , Stuart R. LipsitzStuart R. Lipsitz More articles by this author , Malte VetterleinMalte Vetterlein More articles by this author , Mark A. PrestonMark A. Preston More articles by this author , Nawar HannaNawar Hanna More articles by this author , Adam S. KibelAdam S. Kibel More articles by this author , Maxine SunMaxine Sun More articles by this author , Toni K. ChoueiriToni K. Choueiri More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , and Steven Lee ChangSteven Lee Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2265AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is limited evidence supporting the use of adjuvant chemotherapy (AC) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Against this backdrop, we hypothesized that such treatment is associated with an overall survival (OS) benefit in patients with locally advanced and/or positive regional lymph node disease. METHODS Within the National Cancer Data Base (2004-2012), we identified 3,253 individuals who received AC or observation after RNU for pT3/T4 and/or pN+ UTUC. Inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier curves and Cox regression analyses were used to compare OS of patients in the two treatment groups. Additionally, we performed exploratory analyses of treatment effect according to age, gender, Charlson comorbidity index, pathological stage (pT3/T4N0, pT3/T4Nx and pTanyN+) and surgical margin status. RESULTS Overall, 762 (23.42%) and 2,491 (76.58%) patients with pT3/T4 and/or pN+ UTUC received AC and observation after RNU, respectively. IPTW-adjusted Kaplan-Meier curves showed that median OS was significantly longer for AC vs. observation (47.41[IQR,19.88-112.39] vs. 35.78 [IQR,14.09-99.22] months; P<0.001; Figure 1). The 5-year IPTW-adjusted rates of OS for AC vs. observation were 43.90% vs. 35.85%, respectively. In IPTW-adjusted Cox regression analysis, AC was associated with a significant OS benefit (HR=0.77; 95%CI=[0.68-0.88]; P<0.001). This benefit was consistent across all subgroups examined (all P<0.05) and no significant heterogeneity of treatment effect was observed (all Pinteraction>0.05; Figure 2). CONCLUSIONS We report an OS benefit in patients who received AC vs. observation after RNU for pT3/T4 and/or pN+ UTUC. Although our results are limited by the usual biases related to the observational study design, we believe that the present findings should be considered when advising post-RNU management of advanced UTUC, pending level I evidence. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e948-e949 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Thomas Seisen More articles by this author Ross E. Krasnow More articles by this author Joaquim Bellmunt More articles by this author Morgan Rouprêt More articles by this author Jeffrey J. Leow More articles by this author Stuart R. Lipsitz More articles by this author Malte Vetterlein More articles by this author Mark A. Preston More articles by this author Nawar Hanna More articles by this author Adam S. Kibel More articles by this author Maxine Sun More articles by this author Toni K. Choueiri More articles by this author Quoc-Dien Trinh More articles by this author Steven Lee Chang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...