Selected High-Risk Patients With Upper Tract Urothelial Carcinoma Treated With Radical Nephroureterectomy for Adjuvant Chemotherapy: A Multi-Institutional Retrospective Study

Ikeda, Masaomi; Matsumoto, Kazumasa; Hirayama, Takahiro; Koguchi, Dai; Murakami, Yousuke; Matsuda, Daisuke; Okuno, Norihiko; Utsunomiya, Takuji; Taoka, Yoshinori; Irie, Akira

doi:10.1016/j.clgc.2017.10.014

Cited by 13 publications

(12 citation statements)

References 20 publications

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“…Two of the five criteria included in the pentafecta were related to the quality of surgery: achieving negative surgical margins and performing an en bloc bladder cuff excision. Indeed, several studies have shown that positive surgical margins were associated with worse survival outcomes after RNU [ 3 , 32 , 33 ]. Generally, surgical margins could be avoided by removing the kidney without opening the Gerota’s fascia and avoiding incising the urinary tract or contact between the instruments and the tumor [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Pentafecta for Radical Nephroureterectomy in Patients with High-Risk Upper Tract Urothelial Carcinoma: A Proposal for Standardization of Quality Care Metrics

König

Grossmann

Soria

et al. 2022

Cancers

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Background: Measuring quality of care indicators is important for clinicians and decision making in health care to improve patient outcomes. Objective: The primary objective was to identify quality of care indicators for patients with upper tract urothelial carcinoma (UTUC) and to validate these in an international cohort treated with radical nephroureterectomy (RNU). The secondary objective was to assess the factors associated with failure to validate the pentafecta. Design: We performed a retrospective multicenter study of patients treated with RNU for EAU high-risk (HR) UTUC. Outcome measurements and statistical analysis: Five quality indicators were consensually approved, including a negative surgical margin, a complete bladder-cuff resection, the absence of hematological complications, the absence of major complications, and the absence of a 12-month postoperative recurrence. After multiple imputations and propensity-score matching, log-rank tests and a Cox regression were used to assess the survival outcomes. Logistic regression analyses assessed predictors for pentafecta failure. Results: Among the 1718 included patients, 844 (49%) achieved the pentafecta. The median follow-up was 31 months. Patients who achieved the pentafecta had superior 5-year overall- (OS) and cancer-specific survival (CSS) compared to those who did not (68.7 vs. 50.1% and 79.8 vs. 62.7%, respectively, all p < 0.001). On multivariable analyses, achieving the pentafecta was associated with improved recurrence-free survival (RFS), CSS, and OS. No preoperative clinical factors predicted a failure to validate the pentafecta. Conclusions: Establishing quality indicators for UTUC may help define prognosis and improve patient care. We propose a pentafecta quality criteria in RNU patients. Approximately half of the patients evaluated herein reached this endpoint, which in turn was independently associated with survival outcomes. Extended validation is needed.

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Section: Discussionmentioning

confidence: 99%

Pentafecta for Radical Nephroureterectomy in Patients with High-Risk Upper Tract Urothelial Carcinoma: A Proposal for Standardization of Quality Care Metrics

König

Grossmann

Soria

et al. 2022

Cancers

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“…We selected two retrospectives studies and one prospective trial for this comparison for a total of 809 patients [6,24,27]. A relevant benefit in DFS was identified for patients receiving AC with pooled HR 0.49 (95% CI, 0.36-0.66).…”

Section: Platinum-based Adjuvant Chemotherapy and Diseasefree Survivalmentioning

confidence: 99%

“…Of the 53 reports were retrieved for full-text evaluation. Only 16 studies met the inclusion criteria and were included in this systematic review [6,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Table 1 showed the characteristics of the included studies.…”

Section: Studies Selectedmentioning

confidence: 99%

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Platinum-based adjuvant chemotherapy for upper tract urothelial carcinoma: a change of paradigm? A meta-analysis of aggregate data

et al. 2021

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We performed a systematic review and meta-analysis to evaluate the role of platinum-based adjuvant chemotherapy (AC) in upper tract urothelial carcinoma. Eligible studies were identified using Pubmed/Medline, Cochrane library, Embase and meeting abstracts. Outcomes of interest included: overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS). Platinum-based AC was associated with improved DFS, while the benefit in OS and CSS was not statistically significant compared to observation. Conversely, platinum-based AC showed a modest OS benefit in an analysis combing multivariable HRs with estimated HRs from Kaplan-Meier curves. Our results suggest that platinum-based AC is associated with improved DFS and a modest OS benefit in patients with locally advanced urothelial carcinomas. Anti-Cancer Drugs 33: e61-e68

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“…Urologists may administer perioperative chemotherapy, such as neoadjuvant or adjuvant chemotherapy (AC), to improve prognosis even slightly. Although there were no randomized trials and no prospective studies, available studies suggest that neoadjuvant and AC are associated with improved survival in patients with UTUC [5][6][7]. Recently, AC after RNU was reported to have significantly improved disease-free survival in patients with locally advanced UTUC in the POUT trial, a phase 3 randomized controlled trial [8].…”

Section: Introductionmentioning

confidence: 99%

Oncologic Outcomes of Salvage Chemotherapy in Patients with Recurrent or Metastatic Lesions after Radical Nephroureterectomy: A Multi-Institutional Retrospective Study

et al. 2020

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Background: Radical nephroureterectomy (RNU) is the standard treatment for patients with upper tract urothelial carcinoma (UTUC). However, approximately 25% of patients experience recurrence or metastasis after RNU. This study evaluated the clinical outcome and efficacy of salvage chemotherapy (SC) after recurrence or metastasis. Patients and Methods: Of the 441 nonmetastatic UTUC patients who underwent RNU, 147 patients with recurrent or metastatic lesions were analyzed; patients with bladder cancer recurrence were excluded. Time from disease recurrence or metastasis to cancer-specific survival (CSS) was estimated by the Kaplan-Meier method. Multivariate analyses were performed with the Cox proportional hazards regression model, controlling for the effects of clinicopathological factors. Results: The median time from RNU to disease recurrence or metastasis was 13.2 months. In the recurrent or metastatic sites, 31 cases (21%) were liver. In multivariate analyses, pT stage (≥pT3), time to recurrence (<12 months), and liver metastasis were independently predictive factors. In the risk stratification model for CSS after recurrence, patients were categorized into 2 groups based on pT stage, time to recurrence, and liver metastasis. The low-risk group (0–1 risk factors) included 87 patients, and the high-risk group (2–3 risk factors) included 60 patients. In the high-risk group, 27 patients received SC. The probability of CSS after recurrence or metastasis was higher in patients in the SC group compared to the non-SC group (9.5 vs. 3.7 months; p < 0.001). Conclusion: Two or more risk factors defined the high-risk group for patients with recurrence or metastasis after RNU. SC was associated with improved survival in patients with high-risk UTUC.

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Selected High-Risk Patients With Upper Tract Urothelial Carcinoma Treated With Radical Nephroureterectomy for Adjuvant Chemotherapy: A Multi-Institutional Retrospective Study

Cited by 13 publications

References 20 publications

Pentafecta for Radical Nephroureterectomy in Patients with High-Risk Upper Tract Urothelial Carcinoma: A Proposal for Standardization of Quality Care Metrics

Pentafecta for Radical Nephroureterectomy in Patients with High-Risk Upper Tract Urothelial Carcinoma: A Proposal for Standardization of Quality Care Metrics

Platinum-based adjuvant chemotherapy for upper tract urothelial carcinoma: a change of paradigm? A meta-analysis of aggregate data

Oncologic Outcomes of Salvage Chemotherapy in Patients with Recurrent or Metastatic Lesions after Radical Nephroureterectomy: A Multi-Institutional Retrospective Study

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