A Systematic Review and Meta-analysis of Adjuvant and Neoadjuvant Chemotherapy for Upper Tract Urothelial Carcinoma

Leow, Jeffrey J.; Martin‐Doyle, William; Fay, André P.; Choueiri, Toni K.; Chang, Steven L.; Bellmunt, Joaquim

doi:10.1016/j.eururo.2014.03.003

Cited by 213 publications

(136 citation statements)

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“…7,8,13,14 Several retrospective studies and the meta-analysis of those studies suggested the efficacy of neoadjuvant chemotherapy in patients with locally advanced or high-grade UTUC. [15][16][17] In patients with node-positive UTUC, only a few retrospective studies reported the impact of preoperative chemotherapy on the oncological outcomes. [6][7][8] Youssef et al reported that 18 patients who underwent preoperative chemotherapy (median 6 cycles of GC or MVAC) followed by RNU had better DSS than those who underwent primary RNU, although the difference was not statistically significant (5-year DSS 44% vs 36%, P = 0.06).…”

Section: Discussionmentioning

confidence: 99%

Effect of preoperative chemotherapy on survival of patients with upper urinary tract urothelial carcinoma clinically involving regional lymph nodes

et al. 2015

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Objectives: To determine the effect of preoperative chemotherapy on survival in patients with upper urinary tract urothelial carcinoma clinically involving regional lymph nodes. Methods: We retrospectively analyzed 55 consecutive patients who received radical nephroureterectomy with or without preoperative chemotherapy for upper urinary tract urothelial carcinoma clinically involving regional lymph nodes at a single institution between January 1991 and December 2013. Results: Median follow up was 18 months (range 2-193). Of 55 patients, 24 (43.6%) received preoperative chemotherapy (study group) and 31 (56.4%) underwent primary surgery (control group). Preoperative chemotherapy consisted of two to four cycles (median 3) of cisplatin-containing regimens. The fraction of patients with lower pathological T stage and N stage than clinical T stage and N stage was higher in the study group (29.2% and 54.2%) compared with the control group (3.2% and 16.1%; P = 0.013 and 0.010, respectively). The 5-year overall survival rate was significantly higher in the study group than in the control group (44.0% vs 12.9%, log-rank, P = 0.003). In multivariate analysis incorporating age at diagnosis, Eastern Cooperative Oncology Group Performance Status, clinical N stage and the number of removed lymph nodes, preoperative chemotherapy was a predictor of better overall survival (P = 0.047, HR 0.47, 95% CI 0.22-0.99). Conclusions: Preoperative chemotherapy might provide better survival outcomes in patients with upper urinary tract urothelial carcinoma clinically involving regional lymph nodes.

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Section: Discussionmentioning

confidence: 99%

Effect of preoperative chemotherapy on survival of patients with upper urinary tract urothelial carcinoma clinically involving regional lymph nodes

et al. 2015

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“…In few article you can find the good response of neoadjuvant chemotherapy to downstaging, although survival data need to mature and longer follow-up is awaited [25]. After a comprehensive search of studies examining the role of chemotherapy for upper tract urothelial cancer, the pooled evidence shows that cisplatin-based adjuvant chemotherapy was beneficial for prolonging survival [26]. Chemotherapy followed by retroperitoneal LND for isolated retroperitoneal recurrence after nephroureterectomy for upper UTUC was feasible and safe treatment that may be potentially therapeutic in selected patients.…”

Section: Discussionmentioning

confidence: 99%

Invasive Upper Urinary Tract Urothelial Carcinoma With Atypical Clinic: Case Report

Matulevičius

Štarolis²

2017

Medicinos Teorija Ir Praktika

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Key words: invasive upper tract urothelial carcinoma, radical nephroureterectomy, chemotherapy treatment. Based on literature sources Urothelial carcinomas (UCs) are the fourth most common tumors. They can be located in the lower (bladder and urethra) or upper (pyelocaliceal cavities and ureter) urinary tract. Herein, we report a rare case of upper tract high malignancy urothelial carcinoma with atypical clinic which looks like an apostematous pyelonephritis. Upper tract urothelial carcinomas that invade the muscle wall usually have poor prognosis. Retrospectively assessing our patient has the most common symptoms of urinary tract infection and malignancy. It was non-visible hematuria, flank pain, chronic urinary tract infection, and also systemic symptoms (including anorexia, weight loss, malaise, fatigue, fever, and night sweats). The right diagnose we have determined by biopsy and CTU. Open RNU with bladder cuff excision is the standard for high-risk UTUC, regardless of tumor location and bladder cuff removal is imperative. AC adjuvant chemotherapy is the most widely used treatment in patients with cancer after undergoing surgery. Unfortunately the overall survival rate of urothelial metastatic tumor for this day is poor.

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“…En un meta-análisis realizado por Leow et al (30), encontraron un beneficio en la supervivencia global y la supervivencia libre de enfermedad en los pacientes tratados con Cisplatino administrado de forma adyuvante comparado con aquellos tratados sólo con cirugía, sin embargo observaron una tendencia no significativa hacia la supervivencia cáncer específica. A pesar de estos resultados, hay una evidencia insuficiente para recomendar el uso rutinario de Cisplatino administrado de forma adyuvante para los tumores del TUS, requiriéndose más ensayos clínicos con un mayor número de pacientes.…”

Section: La Urografía Por Resonancia Magnética (Rm) Está Indicada En unclassified

Descriptive analysis of a series of 32 upper urinary tract tumors in a second level hospital

et al. 2014

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Análisis descriptivo de una serie de 32 tumores del tracto urinario superior en un hospital de segundo nivel ResumenIntroducción: El objetivo del estudio es analizar, basándonos en los pacientes tratados en nuestro servicio de tumores del tracto urinario superior, las características epidemiológicas y clínicas así como las variables que han influido en la evolución y mortalidad de estos pacientes. Materiales y Métodos: Se analizaron retrospectivamente 32 pacientes diagnosticados de tumores del tracto urinario superior en el Hospital comarcal Santa Ana de Motril (Granada), en el periodo comprendido entre enero del 2003 y diciembre del 2013. Resultados: La edad media fue de 72,25 años. El 75% eran hombres y el 25% mujeres. El 71.9% eran hipertensos, el 46.9% fumadores. El 18.8% presentaba un tumor vesical en el momento del diagnóstico. El 90.6% debutó con hematuria. El 53.1% se localizó en el lado derecho y el 43.8% en el izquierdo. El 25% se desarrollaron en los cálices, el 46.8% en la pelvis renal y el 50% a nivel ureteral. El estadio anatomopatológico al diagnóstico fue: 6.3% Ta, 25% T1, 28.1% T2, 37.5% T3 y 3.1% T4. El 21.9% eran grado I, el 34.4% grado II y el 43.8% grado III. No se observó recidiva tumoral en ningún paciente, siendo la mortalidad cáncer -específica del 0%. En 8 pacientes se diagnosticó un tumor vesical durante su seguimiento. La media de estancia hospitalaria fue de 7 días. Conclusiones: A pesar de ser una casuística limitada los resultados obtenidos son satisfactorios independientemente de la técnica quirúrgica empleada, al ser la supervivencia libre de enfermedad en el periodo de seguimiento del 100% y la mortalidad cáncer-específica del 0%. AbstractIntroduction: The aim of the study is to analyze, based on patients treated in our department of upper urinary tract tumors, epidemiological and clinical characteristics as well as the variables that have influenced the evolution and mortality of these patients Material and methods: 32 patients diagnosed of upper urinary tract tumors in Santa Ana Hospital of Motril (Granada) between January 2003 and December 2013 were retrospectively analyzed. Results: The mean age was 72.25 years. 75% were male and 25% female. 71.9% were hypertensive, 46.9% were smokers. 18.8% had a bladder tumor at diagnosis. 90.6% debuted with hematuria.53.1% was located on the right side and 43.8% on the left. 25% were developed in the chalices, 46.8% in the renal pelvis and ureteral 50%.The pathologic stage at diagnosis: 6.3% Ta, 25% T1, 28.1% T2, 37.5% T3 and 3.1% T4. 21.9% were grade I, grade II 34.4% and 43.8% grade III. No tumor recurrence was observed in any patient being cancer -specific mortality of 0%. In 8 patients bladder tumor was diagnosed during follow-up. The mean hospital stay was 7 days. Conclusions: Despite being limited casuistry the results are satisfactory regardless of the surgical technique used, being disease-free survival in the follow-up period of 100% and cancer-specific mortality of 0%. Enviado: 02-12-2014 Revisado: 22-12-2014 Aceptado: 29-12-...

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A Systematic Review and Meta-analysis of Adjuvant and Neoadjuvant Chemotherapy for Upper Tract Urothelial Carcinoma

Cited by 213 publications

References 51 publications

Effect of preoperative chemotherapy on survival of patients with upper urinary tract urothelial carcinoma clinically involving regional lymph nodes

Effect of preoperative chemotherapy on survival of patients with upper urinary tract urothelial carcinoma clinically involving regional lymph nodes

Invasive Upper Urinary Tract Urothelial Carcinoma With Atypical Clinic: Case Report

Descriptive analysis of a series of 32 upper urinary tract tumors in a second level hospital

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