Abstract
Objectives: To estimate the stage-specific impact of perioperative chemotherapy on survival for upper urinary tract urothelial carcinoma (UTUC) patients treated with nephroureterectomy (NU).Methods: Overall, 7,278 UTUC patients treated with NU from 2004 to 2015 were identified within the SEER database. Kaplan–Meier plots were used to elucidate overall survival (OS) and cancer-specific survival (CSS) rates. Multivariable Cox regression analyses were used to test the impact of chemotherapy on survival rates, after stratifying according to pathological stage.Results: Chemotherapy was performed in 17.3% of patients and in 5.7, 11.5, 25.4, and 51.3% of patients with, respectively, pT1, pT2, pT3, and pT4 disease (P < 0.001). In multivariable analyses, perioperative chemotherapy was associated with a lower OS in pT2 patients and a lower CSS in pT1 disease (both P < 0.05), while predisposed to a higher OS in pT3 and pT4 patients (both P < 0.01). Moreover, perioperative chemotherapy was prone to a higher OS or CSS in pN+ disease compared to no chemotherapy (both P < 0.01).Conclusion: Perioperative chemotherapy was more frequently performed in locally advanced UTUC patients. The beneficial effect of chemotherapy on OS was evident in pT3/pT4 and pN+ patients. In addition, a clear CSS benefit was observed in patients who received chemotherapy for pN+ UTUC, while perioperative chemotherapy may reduce CSS for pT1 and OS for pT2 patients following NU.
Highlights
Upper urinary tract urothelial carcinomas (UTUCs), accounting for only 5–10% of urothelial carcinomas (UCs), are rare malignancies arising from the renal pelvis or ureters with different anatomic and biological attributes from lower tract urothelial malignancies [1, 2]
When comparing the characteristics of the two groups, we observed that patients who received perioperative chemotherapy were younger than the no/unknown group (67.6 ± 10.1 vs. 72.8 ± 10.7 years old, P < 0.001)
Perioperative chemotherapy was frequently performed in non-white race, married, higher tumor
Summary
Upper urinary tract urothelial carcinomas (UTUCs), accounting for only 5–10% of urothelial carcinomas (UCs), are rare malignancies arising from the renal pelvis or ureters with different anatomic and biological attributes from lower tract urothelial malignancies [1, 2]. It is reasonable to consider perioperative chemotherapy in an effort to decrease recurrence risk. A cohort study of patients fit enough to receive systemic chemotherapy for metastatic UTUC reported an overall survival (OS) benefit to combine chemotherapy and NU [4], while a recent multi-center study found that adjuvant chemotherapy after NU did not improve OS compared to observation [5]. This may result from the dilemma to determine which types of patients are suitable for perioperative chemotherapy. The most frequent adverse reaction of cisplatinbased regimen is nephrotoxicity [6], which may significantly reduce survival in patients with postoperative renal dysfunction [7, 8]
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