Faysal A Yafi1, Simon Tanguay1, Ricardo Rendon2, Niels Jacobsen3, Adrian Fairey3, Jonathan Izawa4, Anil Kapoor5, Peter Black6, Louis Lacombe7, Joe Chin4, Alan So6, Jean-Baptiste Lattouf8, David Bell2, Yves Fradet7, Fred Saad8, Edward Matsumoto5, Darrel Drachenberg9, Ilias Cagiannos10, Wassim Kassouf11. 1. Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada. 2. Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada. 3. Department of Surgery (Urology), University of Alberta, Edmonton, Alberta, Canada. 4. Department of Surgery (Urology), University of Western Ontario, London, Ontario, Canada. 5. Department of Surgery (Urology), McMaster University, Hamilton, Ontario, Canada. 6. Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada. 7. Department of Surgery (Urology), Laval University, Quebec, Quebec, Canada. 8. Department of Surgery (Urology), University of Montreal, Montreal, Quebec, Canada. 9. Department of Surgery (Urology), University of Manitoba, Winnipeg, Manitoba, Canada. 10. Department of Surgery (Urology), University of Ottawa, Ottawa, Ontario, Canada. 11. Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada. Electronic address: wassim.kassouf@muhc.mcgill.ca.
Abstract
OBJECTIVES: Upper-tract urothelial carcinoma (UTUC) is associated with poor outcomes. Our aim was to assess adequacy of renal function and evaluate the role of adjuvant chemotherapy (AC) in patients with UTUC treated by radical nephroureterectomy (RNU) in a universal health care system. MATERIALS AND METHODS: Retrospective data from 1,029 patients treated with RNU across 10 Canadian academic centers were collected. Tested variables included various clinico-pathological parameters, the use of perioperative chemotherapy, preoperative and postoperative creatinine values, and estimated glomerular filtration rates (eGFR). Univariable and multivariable Cox regression models addressed overall survival and disease-specific survival after surgery. Kaplan-Meier survival curves were used to compare outcomes in patients who received or did not receive AC. RESULTS: Median age of patients was 70 years with a median follow-up of patients who were alive of 26 months. The median preoperative and postoperative eGFR rates were 59 mL/min/1.73 m(2) and 47 mL/min/1.73 m(2), respectively. Using a cutoff eGFR of 60, 49% of all the patients and 48% of the patients with ≥ pT3 or pTxN+ or both diseases would have been eligible for cisplatin-based chemotherapy preoperatively and only 18% and 21% of the patients, respectively remained eligible postoperatively. Of the patients who received AC, 75% had an eGFR<60. On multivariate analysis, AC was not prognostic for improved overall survival or disease-specific survival. CONCLUSIONS: Chronic kidney disease is common in patients with UTUC. Following RNU, 57% of the high-risk patients with good preoperative renal function became ineligible for cisplatin-based chemotherapy. Use of AC did not translate into improved survival. Whether this is due to inherent biases of retrospective analysis, limited efficacy of AC in patients with UTUC, or use of suboptimal regimen or dose because of poor postoperative renal function requires further evaluation.
OBJECTIVES:Upper-tract urothelial carcinoma (UTUC) is associated with poor outcomes. Our aim was to assess adequacy of renal function and evaluate the role of adjuvant chemotherapy (AC) in patients with UTUC treated by radical nephroureterectomy (RNU) in a universal health care system. MATERIALS AND METHODS: Retrospective data from 1,029 patients treated with RNU across 10 Canadian academic centers were collected. Tested variables included various clinico-pathological parameters, the use of perioperative chemotherapy, preoperative and postoperative creatinine values, and estimated glomerular filtration rates (eGFR). Univariable and multivariable Cox regression models addressed overall survival and disease-specific survival after surgery. Kaplan-Meier survival curves were used to compare outcomes in patients who received or did not receive AC. RESULTS: Median age of patients was 70 years with a median follow-up of patients who were alive of 26 months. The median preoperative and postoperative eGFR rates were 59 mL/min/1.73 m(2) and 47 mL/min/1.73 m(2), respectively. Using a cutoff eGFR of 60, 49% of all the patients and 48% of the patients with ≥ pT3 or pTxN+ or both diseases would have been eligible for cisplatin-based chemotherapy preoperatively and only 18% and 21% of the patients, respectively remained eligible postoperatively. Of the patients who received AC, 75% had an eGFR<60. On multivariate analysis, AC was not prognostic for improved overall survival or disease-specific survival. CONCLUSIONS:Chronic kidney disease is common in patients with UTUC. Following RNU, 57% of the high-risk patients with good preoperative renal function became ineligible for cisplatin-based chemotherapy. Use of AC did not translate into improved survival. Whether this is due to inherent biases of retrospective analysis, limited efficacy of AC in patients with UTUC, or use of suboptimal regimen or dose because of poor postoperative renal function requires further evaluation.
Authors: Atiqullah Aziz; Jakub Dobruch; Kees Hendricksen; Luis A Kluth; Andrea Necchi; Aidan Noon; Michael Rink; Florian Roghmann; Roland Seiler; Paolo Gontero; Wassim Kassouf; Shahrokh F Shariat; Evanguelos Xylinas Journal: World J Urol Date: 2017-01-10 Impact factor: 4.226
Authors: Evanguelos Xylinas; Luis Kluth; Malte Rieken; Morgan Rouprêt; Bashir Al Hussein Al Awamlh; Thomas Clozel; Maxine Sun; Pierre I Karakiewicz; Mithat Gonen; Shahrokh F Shariat Journal: Urol Oncol Date: 2016-11-03 Impact factor: 3.498