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

Abstract

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.

Platinum-based Neoadjuvant Chemotherapy Improves Oncological Outcomes in Patients with Locally Advanced Upper Tract Urothelial Carcinoma

“…The benefit of NAC has been debated for locally advanced UTUC on the basis of studies of bladder cancer indicating improved survival after cisplatin-based NAC [5]. Several retrospective studies addressed the prognostic benefit of NAC for UTUC [6][7][8][9][10][11]. However, only a few prospective studies assessed the benefit of NAC for UTUC [4,12] and there are no definitive recommendations because of insufficient evidence such as data on appropriate regimens [4,13].…”

Oncological outcomes of neoadjuvant chemotherapy in patients with locally advanced upper tract urothelial carcinoma: a multicenter study

“…The benefit of NAC for locally advanced UTUC has been debated based on studies of bladder cancer indicating improved survival after cisplatin-based NAC [ 7 ]. Several retrospective studies have addressed the prognostic benefit of NAC for UTUC [ 8 – 13 ]. Recently, we reported the oncological benefits of NAC for locally advanced UTUC in a single-center study [ 14 ].…”

Current role of lymphadenectomy in the upper tract urothelial carcinoma

“…In a systematic review and meta-analysis of adjuvant and neoadjuvant chemotherapy for upper tract urothelial carcinoma published in 2014 [29], the authors conclude that there might be a role for cisplatin-based AC in UTUC patients who have adequate postoperative renal function and high-risk disease (pT3,pN+, positive surgical margins), but insufficient evidence currently exists to recommend routine use of AC for all UTUC patients. Recently, Kobayashi et al [30] determined the effect of preoperative chemotherapy (PC) on survival in 55 patients with UTUC clinically involving regional lymph nodes at a single institution between 1991–2013. PC consisted of two-four cycles of cisplatin-containing regimens.…”