Adjuvant chemotherapy after radical nephroureterectomy does not improve survival in patients with upper tract urothelial carcinoma: a joint study by the European Association of Urology–Young Academic Urologists and the Upper Tract Urothelial Carcinoma Collaboration

Necchi, Andrea; Vullo, Salvatore Lo; Mariani, Luigi; Moschini, Marco; Hendricksen, Kees; Rink, Michael; Sosnowski, Roman; Dobruch, Jakub; Raman, Jay D.; Wood, Christopher G.; Margulis, Vitaly; Rouprêt, Morgan; Briganti, Alberto; Montorsi, Francesco; Xylinas, Évanguelos; Shariat, Shahrokh F.

doi:10.1111/bju.14020

Cited by 60 publications

(46 citation statements)

References 30 publications

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“…Perioperative systemic therapy might be beneficial in locally advanced UTUC, but it is still a controversial issue. 6,[20][21][22] Different etiologies might be associated with different tumoral mutations, and we still do not understand whether the benefit of systemic therapy can be observed in different populations.…”

Section: Discussionmentioning

confidence: 99%

“…There is an unusual presentation of high prevalence and female predominance for upper UTUC in the Taiwan and China area . In other Asian areas, such as Japan and Korea, European and American countries, the male:female ratio is from 1.223:2.860 . However, the male:female ratio in Taiwan and China is 0.773:0.838 .…”

Section: Introductionmentioning

confidence: 98%

“…[1][2][3] In other Asian areas, such as Japan and Korea, European and American countries, the male:female ratio is from 1.223:2.860. [4][5][6][7] However, the male:female ratio in Taiwan and China is 0.773:0.838. [1][2][3] Several reports attributed this phenomenon to carcinogen exposure, such as arsenic and aristolochic acid.…”

Section: Introductionmentioning

confidence: 99%

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Unusual presentation of upper urinary tract urothelial carcinoma in Taiwan: Direct comparison from Taiwan‐Japan UTUC Collaboration Cohort

et al. 2020

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Objectives To carry out a comparison of upper urinary tract urothelial carcinoma characteristics and behavior between patients in Taiwan and Japan. Methods A Taiwan urinary tract urothelial carcinoma cohort was obtained from Kaohsiung Chang Gung Memorial Hospital, and a Japan urinary tract urothelial carcinoma cohort from Hirosaki University Hospital. The inclusion criteria were urinary tract urothelial carcinoma patients who underwent radical nephroureterectomy. Those who received perioperative chemotherapy were excluded. Finally, 765 patients in the Taiwan cohort and 325 in the Japan cohort were analyzed. The end‐point of this study was to study the natural course of urinary tract urothelial carcinoma within 5 years between these two groups. Results The main finding was that urinary tract urothelial carcinoma patients in Taiwan were younger (P < 0.001), more were women (P < 0.001), with low‐stage disease (P < 0.001), with more chronic kidney disease (P < 0.001), with less smoking history (P < 0.001), with more bladder cancer history (P = 0.002), with more multifocal (P < 0.001) and less high‐grade disease (P = 0.015), as well as less lymphovascular invasion (P < 0.001) and more squamous differentiation (P < 0.001). However, the multivariate Cox regression analysis showed no racial difference in oncologic outcome, such as intravesical recurrence, systemic recurrence or cancer‐specific death in primary and propensity‐matched cohorts. Bladder cancer history was found to be the most important factor predicting intravesical recurrences, whereas stage was strongly associated with systemic recurrence and cancer specific mortality. Conclusions The clinical characteristics of urinary tract urothelial carcinoma in Taiwan are significantly different from those of urinary tract urothelial carcinoma in Japan. However, there is no racial difference in stage‐specific oncologic outcome after standard nephroureterectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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Unusual presentation of upper urinary tract urothelial carcinoma in Taiwan: Direct comparison from Taiwan‐Japan UTUC Collaboration Cohort

et al. 2020

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“…However, there might be several additional biases of patient selection that might have affected the observed outcomes, and such factors cannot be fully acknowledged retrospectively, even with application of advanced statistical methods, similar to what we have recently experienced in another context. 18 Additionally, data in the RISC data set were mainly provided by oncologists, therefore it is likely that the RISC population suffered from an unavoidable enrichment in patients with the poorest outcome. This might the reason why the proportion of locoregional relapses was close to the upper bound of the range reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Development of a Prediction Tool for Exclusive Locoregional Recurrence After Radical Cystectomy in Patients With Muscle-Invasive Bladder Cancer

Necchi

Pond

Moschini

et al. 2019

Clinical Genitourinary Cancer

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We analyzed prognostic factors and developed a prediction tool for exclusive locoregional (pelvic) recurrences after radical cystectomy for bladder cancer. We identified a subgroup of patients with the highest risk who might be best suited for clinical studies. Background: Limited information is available about the pattern of relapse after perioperative chemotherapy with radical cystectomy (RC) vs. RC alone in muscle-invasive bladder cancer. Patients and Methods: Data from 1082 patients of the Retrospective International Study of Invasive/Advanced Cancer of the Urothelium database, treated from February 1990 to December 2013 at 27 centers in the United States, Europe, Israel, and Canada, were collected. Locoregional relapse was defined as any pelvic lymph node or soft tissue-only recurrences. Cumulative incidence methods were used to estimate time to locoregional relapse (TTR L). Cox regression analyses were performed and a nomogram for 12-month locoregional relapse-free survival (RFS) was developed. The nomogram was applied to an external data set (n = 1021). Results: A total of 517 patients (47.8%) developed a relapse: 177 (16.4%) exclusive locoregional relapse. In multivariable analyses, perioperative chemotherapy was associated with longer TTR L (P < .001). Other factors were nonurothelial histology (P = .013), pT-stage (P < .001), and surgical margins (P < .001). The concordance index of the model was 0.681 (95% bootstrapped confidence interval, 0.666-0.716). Risk group categories were obtained according to nomogram tertiles. Despite, overall, observed locoregional RFS in the validation cohort exceeding predicted results, for high-risk patients (80 points or less, lowest nomogram tertile) observed 12-month RFS was similar between development and validation cohorts (60.1% and 66.6%). The study is limited by its retrospective nature. Conclusion: In the largest study, to our knowledge, that analyzed locoregional recurrences after RC, we propose a risk prediction tool for exclusive locoregional failures that might be suitable for clinical studies. Patients best suited for adjuvant radiotherapy might be those within the lowest nomogram tertile. Prospective trials are needed to validate findings.

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“…However, the role of perioperative chemotherapy for patients treated with NU remains controversial. 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.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Chemotherapy on Survival in Patients With Upper Urinary Tract Urothelial Carcinoma Undergoing Nephroureterectomy: A Population-Based Study

Zhai

Jin

Feng³

et al. 2020

Front. Oncol.

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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.

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Adjuvant chemotherapy after radical nephroureterectomy does not improve survival in patients with upper tract urothelial carcinoma: a joint study by the European Association of Urology–Young Academic Urologists and the Upper Tract Urothelial Carcinoma Collaboration

Cited by 60 publications

References 30 publications

Unusual presentation of upper urinary tract urothelial carcinoma in Taiwan: Direct comparison from Taiwan‐Japan UTUC Collaboration Cohort

Unusual presentation of upper urinary tract urothelial carcinoma in Taiwan: Direct comparison from Taiwan‐Japan UTUC Collaboration Cohort

Development of a Prediction Tool for Exclusive Locoregional Recurrence After Radical Cystectomy in Patients With Muscle-Invasive Bladder Cancer

Perioperative Chemotherapy on Survival in Patients With Upper Urinary Tract Urothelial Carcinoma Undergoing Nephroureterectomy: A Population-Based Study

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