Adjuvant chemotherapy for locally advanced upper tract urothelial carcinoma: updated results of the Seoul National university hospital experience

Abstract

Objectives: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.

Role of Adjuvant Chemotherapy in Advanced Stage Upper Urinary Tract Urothelial Carcinoma after Radical Nephroureterectomy: Competing Risk Analysis after Propensity Score-Matching

“…Kim et al . 8 also found no significant disease-specific or overall survival benefits associated with ACH in 138 patients who underwent RNU for locally advanced UTUC (pT3/4 or pN (+)). Conversely, Seisen and colleague evaluated 3,253 individuals with pT3/4 and/or pN (+) who received ACH or observation following RNU, and found that ACH was significantly associated with OS benefits in both the overall population (HR = 0.77) and all subgroups evaluated 11.…”

“…Thus, a definitive recommendation is unlikely until high-quality evidence from randomized prospective trials is obtained in patients with UTUC. Moreover, retrospective studies have shown conflicting results regarding the effects of ACH on oncological outcomes in patients with UTUC 8-11. In this regard, the role of ACH for patients with advanced stage UTUC remains an open question.…”

Platinum-based adjuvant chemotherapy for upper tract urothelial carcinoma: a change of paradigm? A meta-analysis of aggregate data

“…Of the 53 reports were retrieved for full-text evaluation. Only 16 studies met the inclusion criteria and were included in this systematic review [6,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Table 1 showed the characteristics of the included studies.…”

“…Risk of bias were moderate in 8 studies [18][19][20][21][22]24,26,27] and low in 7 studies [13][14][15][16][17]23,25]. The one RCT scored 3 in the Jadad scale [6] (Supplementary Materials Table S1, S2, Supplemental digital content 1, http://links.lww.…”

Impact of a bladder cuff excision during radical nephroureterectomy on cancer specific survival in patients with upper tract urothelial cancer in Korea: a retrospective, multi-institutional study

“…19 in a Korean study by Kim et al, bladder cuffing was the sole independent prognostic factor for disease specific survival among patients with stage III or iv UTUc. 20 lughezzani et al evaluated the prognostic significance of BCE during RNU for cSS in a large-scale population-based cohort of patients with renal pelvic tumors. 12 They showed that there was no increase in cancer-related death in patients with localized (pT1-2n0/x) renal pelvic tumors when Bce was omitted and that cSS might decrease significantly if BCE was not performed in patients with locally advanced (pT3-4n0/x and pT[any]N1-3) renal pelvic tumors.…”