Role of adjuvant chemotherapy for lymph node‐positive upper tract urothelial carcinoma and the prognostic significance of C‐reactive protein: A multi‐institutional, retrospective study

Abstract

Objective: To analyze the role of adjuvant chemotherapy in lymph node-positive patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy, and identified the prognostic adjuvant chemotherapy parameters. Methods: The clinicopathological records of 74 lymph node-positive upper tract urothelial carcinoma patients who underwent radical nephroureterectomy at multiple institutions were retrospectively reviewed. A total of 45 patients (60.8%) received adjuvant chemotherapy, and 29 (39.2%) underwent radical nephroureterectomy only. Kaplan-Meier analyses and Cox proportional hazard modeling were used to study the association between adjuvant chemotherapy status and both recurrence-free survival and cancer-specific survival. Results: Estimated 5-year recurrence-free survival was 33.6% in patients undergoing radical nephroureterectomy plus adjuvant chemotherapy compared with 13.5% in patients undergoing radical nephroureterectomy only (hazard ratio 0.52; P = 0.014, logrank test). Estimated 5-year cancer-specific survival was 42.5% in patients undergoing radical nephroureterectomy plus adjuvant chemotherapy, compared with 12.0% in patients undergoing radical nephroureterectomy only (hazard ratio 0.36; P = 0.0003, log -rank test). Multivariate analysis showed that adjuvant chemotherapy was a significant prognostic factor for cancer-specific survival (P = 0.001), but not for recurrence-free survival (P = 0.076). When patients undergoing radical nephroureterectomy plus adjuvant chemotherapy were dichotomized, based on preoperative C-reactive protein levels above or below the normal value, higher C-reactive protein levels were significantly associated with poor survival (P = 0.012). Conclusion: Adjuvant chemotherapy seems to improve cancer-specific survival in lymph node-positive patients with upper tract urothelial carcinoma. Preoperative Creactive protein levels could carry a prognostic value in this setting, and lymph nodepositive patients with low preoperative CRP values should be considered for adjuvant chemotherapy. Further studies are necessary to validate these observations.

Lymph node dissection during nephroureterectomy: Establishing the existing evidence based on a review of the literature

“…There were no randomised controlled trials (RCTs). In all, 21 studies [24][25][26][27][28][29][30]32,33,36,38,39,[41][42][43][44][45][46][47][48][49] collected data retrospectively, one paper [37] collected data prospectively, and one paper [31] collected data both retrospectively and prospectively. In all, 17 papers included details of cohorts who had not undergone LND as a comparative cohort [24,27,28,[31][32][33][35][36][37][39][40][41][42][43]45,47,50].…”

“…In all, 23 papers [24][25][26]28,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]46,47,49,50] included patients regardless of pT stage, two papers included patients only with pT2-4 disease [27,29], and one paper only included patients with pT4 disease [48]. One paper [45] did not include data on pT stage of the patients included.…”

“…In all, 12 studies presented data on RFS after LND [26,28,[30][31][32]36,[41][42][43][47][48][49]. Most of these papers reported RFS at 5 years from surgery.…”

“…In all, 16 papers reported CSS [26,28,[30][31][32]34,36,37,[39][40][41][42][43]45,48,49]. Nine studies provided 5-year CSS comparing patients who underwent LND (3628 patients) with patients who did not (3597) [28,33,36,[39][40][41][42][43]45].…”

Impact of neutrophil-to-lymphocyte ratio on effects of targeted therapy for metastatic renal cell carcinoma patients with extrapulmonary metastasis

“…8,9 Parameters of inflammatory response, such as C-reactive protein (CRP), have been reported as prognostic markers in urological cancers. [10][11][12] The implication of CRP for predicting the prognosis or the effect of agents has also been demonstrated with targeted therapy in RCC. 13 Besides CRP, the elevation of the neutrophils-to-lymphocytes ratio (NLR) has been reported as a prognostic factor in cancers, including RCC.…”