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

Zhai, Ting‐Shuai; Jin, Liang; Feng, Li-Ming; Zhou, Zhen; Liu, Xiang; Liu, Huan; Ma, Wei-Guo; Lu, Jingyi; Chen, Wei; Yao, Xudong; Lin, Ye

doi:10.3389/fonc.2020.00481

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…Goldberg, H et al stated that perioperative chemotherapy had no effect on cancer specific mortality in high-risk non-metastatic patients through SEER database [ 13 ]. However, Zhai, T. S. et al found that the beneficial effect of perioperative chemotherapy on OS was to be evident in pT3/pT4 and pN + patients but to reduce cancer-specific survival for pT1 and OS for pT2 patients [ 14 ]. For low-risk UTUC patients, the benefits of perioperative chemotherapy need to be carefully weighed against the risk.…”

Section: Discussionmentioning

confidence: 99%

Prognostic nomogram for overall survival in upper urinary tract urothelial carcinoma (UTUC) patients treated with chemotherapy: a SEER-based retrospective cohort study

Tian

et al. 2023

BMC Urol

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Objective To establish a prognostic nomogram among UTUC patients who received chemotherapy. Methods 1195 UTUC patients who received chemotherapy were extracted from the Surveillance, Epidemiology, and End Results (SEER) database for the period between 2004 and 2015. Patients were randomly divided into a training and a validation set. Nomogram was constructed to predict 1-, 3-, and 5-year overall survival (OS) in those patients. Receiver-operating characteristic curves (ROCs), calibration plots, and Decision curve analysis (DCA) were applied to assess and compare the discrimination, accuracy, and practicability of the nomogram with 8th American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging system. Results Six clinical parameters were identified as independent prognostic factors for UTUC patients’ OS, including age, marital status, TNM stage, and surgical methods of the primary site. The ROC curves showed a satisfactory discrimination capacity of the nomogram, with 1-, 3-, and 5-year area under curve (AUC) values of 0.789, 0.772, and 0.763 in the training set and 0.772, 0.822, and 0.814 in the validation set, respectively. Calibration curves indicated a good agreement between actual observation and nomogram prediction. ROC and DCA curves showed our nomograms exhibited larger benefits than the 8th AJCC-TNM staging system. Conclusions A prognostic nomogram was established and validated to present individual predictions of OS among chemotherapeutic UTUC patients. This nomogram may assist clinicians in accurate survival prognostication, treatment decision-making, and design of future clinical trials.

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Section: Discussionmentioning

confidence: 99%

Prognostic nomogram for overall survival in upper urinary tract urothelial carcinoma (UTUC) patients treated with chemotherapy: a SEER-based retrospective cohort study

Tian

et al. 2023

BMC Urol

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“…These results might suggest improved patient care in regard to tumor stage is one major prognostic factor after RNU [20]. Five-year CSS for patients undergoing RNU decreases from 89.3% for pT1 to 78.2% for pT2 [21]. Additionally, recurrence rate differs significantly already between noninvasive pTa/pTis and pT1 UTUC [22].…”

Section: Discussionmentioning

confidence: 90%

The Impact of Fluorescence in situ Hybridization on the Staging of Upper Tract Urothelial Carcinoma

et al. 2021

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Objectives: The aim of the study was to evaluate the impact of fluorescence in situ hybridization (FISH) diagnostics on the T stage in final histology specimen of patients undergoing radical nephroureterectomy (RNU) due to upper tract urothelial carcinoma (UTUC) at a large tertiary care center. Methods: We retrospectively analyzed patients who underwent RNU at our center between 2008 and 2020. Inclusion criteria were RNU due to UTUC. Urine cytologies were used for FISH analysis to detect chromosomal abnormalities. Pre-FISH group was defined as patients without access to routine preoperative urinary FISH testing (2008–2014), and FISH group was defined as patients with access to routine FISH testing. Primary outcome was T stage in final histology. Statistical analysis was performed by χ2 test and Mann-Whitney U test. Results: Out of 212 patients who underwent RNU at our center between 2008 and 2020, 155 patients were included into the final analysis. The median age was 71 (range 33–90) years, and 108 (69.7%) patients were male and 47 (30.3%) female. Age and gender were not differently distributed in both groups (age: p = 0.925; gender: p = 0.682). Organ-confined disease was found in 37/72 patients in the pre-FISH cohort and in 48/83 patients in the FISH cohort (p = 0.422). Within organ-confined disease, 18/37 patients revealed a T stage smaller than T1 in the pre-FISH cohort and 35/48 patients in the FISH cohort (p = 0.022). Conclusions: Preoperative FISH diagnostics add important information to preoperative diagnostic workup of patients with UTUC. Within organ-confined disease, a significant shift toward T stages lower than T1 is observed. Further research is required to determine the impact of this shift on survival in UTUC.

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“…Previous studies have shown that perioperative chemotherapy improves the OS in patients with pT3/pT4 and pN+ disease but it reduces the CSS for those with pT1 and OS for those with pT2 disease. [ 28 ] Hence, perioperative chemotherapy may be an overkill in patients with low-risk disease, and hence, identifying high-risk patients with a preoperative NLR might help in reducing the over treatment with chemotherapy. Future research might explore the role of NLR as a factor to stratify high-risk patients and to identify those who can benefit from neoadjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

The prognostic role of preoperative neutrophil-to-lymphocyte ratio in upper tract urothelial carcinoma

Ghorai,

Nayak,

Goel

et al. 2024

Indian Journal of Urology

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Introduction: The blood-based inflammatory marker, neutrophil-to-lymphocyte ratio (NLR), is a reliable prognostic biomarker for several cancers. Although the literature supports the correlation between preoperative NLR, clinicopathological characteristics, and oncological outcomes in upper tract urothelial carcinoma (UTUC), the cutoff of NLR is still debated. This study aimed to determine the prognostic value of NLR in patients with UTUC. Methods: This was a retrospective analysis of prospectively collected data from July 2012 to December 2022 evaluating patients with UTUC who underwent radical nephroureterectomy (RNU). NLR was calculated using the neutrophil and lymphocyte counts obtained a day before the surgery and the cutoff value was set as 2.5. Kaplan–Meier and Cox’s proportional hazards regression were used to analyze the association between NLR and the oncological outcomes. Results: The study included 91 patients (78 males, 13 females) in the final analysis with a median follow-up of 49 months (8–130). The mean age of the patients with NLR <2.5 and NLR ≥2.5 was 56.88 years and 56.35 years, respectively, and the pathological stage was pT1 in 48%, pT2 in 20.88%, pT3 in 27.47%, and pT4 in 3.30% of the patients. Multivariable Cox regression analysis showed that the preoperative NLR ≥2.5 was significantly associated (Hz = 7.17) with higher T stage, lymphovascular invasion, necrosis, nodal involvement, adjuvant chemotherapy, and worse overall survival (OS) (Hz = 9.87). The Kaplan–Meier analysis revealed an improved OS in patients with NLR <2.5, but a statistically significant difference in the recurrence-free survival was not found. Conclusions: Preoperative NLR is an easily available, inexpensive, and important prognostic biomarker of survival in patients with UTUC and has a potential role in risk stratification by predicting adverse clinicopathological characteristics.

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

Cited by 6 publications

References 18 publications

Prognostic nomogram for overall survival in upper urinary tract urothelial carcinoma (UTUC) patients treated with chemotherapy: a SEER-based retrospective cohort study

Prognostic nomogram for overall survival in upper urinary tract urothelial carcinoma (UTUC) patients treated with chemotherapy: a SEER-based retrospective cohort study

The Impact of Fluorescence in situ Hybridization on the Staging of Upper Tract Urothelial Carcinoma

The prognostic role of preoperative neutrophil-to-lymphocyte ratio in upper tract urothelial carcinoma

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