BACKGROUND: High-grade upper tract urothelial carcinoma (UTUC) is frequently upstaged after surgery and is associated with uniformly poor survival. Neoadjuvant chemotherapy may offer a way to improve clinical outcomes. The authors compared the survival rates of patients with UTUC who received neoadjuvant chemotherapy before surgery with the rates among patients who did not. METHODS: A retrospective review was conducted of patients with high-risk UTUC who received neoadjuvant chemotherapy followed by surgery from 2004 to 2008 (study group) compared with a matched cohort who underwent initial surgery from 1993 to 2003 (control group). Fisher exact tests, Wilcoxon rank-sum tests, and Kaplan-Meier methods were used. The log-rank test and Cox proportional-hazards models were used to evaluate the association of the 2 outcomes with patient, treatment, and tumor characteristics in univariate and multivariate models. RESULTS: Of 112 patients, there were 31 in the study group and 81 in the control group. Patients who received neoadjuvant chemotherapy had improved overall survival (OS) and disease-specific survival (DSS) with a 5-year DSS rate of 90.1% and a 5-year OS rate of 80.2% versus DSS and OS rates of 57.6% for those who underwent initial surgery (P = .0204 and P = .0015, respectively). In multivariate analyses, the neoadjuvant group had a lower risk of mortality (OS: hazard ratio, 0.42 [P = .035]; DSS: hazard ratio, 0.19 [P = .006]). CONCLUSIONS: Neoadjuvant chemotherapy improved the survival of patients with UTUC compared with a matched historic cohort of patients who underwent initial surgery. Patients with high-risk UTUC should be considered for neoadjuvant chemotherapy in view of the limited opportunity to administer effective cisplatin-based chemotherapy after nephroureterectomy.
BACKGROUND: High-grade upper tract urothelial carcinoma (UTUC) is frequently upstaged after surgery and is associated with uniformly poor survival. Neoadjuvant chemotherapy may offer a way to improve clinical outcomes. The authors compared the survival rates of patients with UTUC who received neoadjuvant chemotherapy before surgery with the rates among patients who did not. METHODS: A retrospective review was conducted of patients with high-risk UTUC who received neoadjuvant chemotherapy followed by surgery from 2004 to 2008 (study group) compared with a matched cohort who underwent initial surgery from 1993 to 2003 (control group). Fisher exact tests, Wilcoxon rank-sum tests, and Kaplan-Meier methods were used. The log-rank test and Cox proportional-hazards models were used to evaluate the association of the 2 outcomes with patient, treatment, and tumor characteristics in univariate and multivariate models. RESULTS: Of 112 patients, there were 31 in the study group and 81 in the control group. Patients who received neoadjuvant chemotherapy had improved overall survival (OS) and disease-specific survival (DSS) with a 5-year DSS rate of 90.1% and a 5-year OS rate of 80.2% versus DSS and OS rates of 57.6% for those who underwent initial surgery (P = .0204 and P = .0015, respectively). In multivariate analyses, the neoadjuvant group had a lower risk of mortality (OS: hazard ratio, 0.42 [P = .035]; DSS: hazard ratio, 0.19 [P = .006]). CONCLUSIONS: Neoadjuvant chemotherapy improved the survival of patients with UTUC compared with a matched historic cohort of patients who underwent initial surgery. Patients with high-risk UTUC should be considered for neoadjuvant chemotherapy in view of the limited opportunity to administer effective cisplatin-based chemotherapy after nephroureterectomy.
Authors: R Millikan; C Dinney; D Swanson; P Sweeney; J Y Ro; T L Smith; D Williams; C Logothetis Journal: J Clin Oncol Date: 2001-10-15 Impact factor: 44.544
Authors: Maike F Eylert; Luke Hounsome; Julia Verne; Amit Bahl; Edward R Jefferies; Raj A Persad Journal: BJU Int Date: 2013-03-07 Impact factor: 5.588
Authors: Nicholas J Hellenthal; Shahrokh F Shariat; Vitaly Margulis; Pierre I Karakiewicz; Marco Roscigno; Christian Bolenz; Mesut Remzi; Alon Weizer; Richard Zigeuner; Karim Bensalah; Casey K Ng; Jay D Raman; Eiji Kikuchi; Francesco Montorsi; Mototsugu Oya; Christopher G Wood; Mario Fernandez; Christopher P Evans; Theresa M Koppie Journal: J Urol Date: 2009-07-17 Impact factor: 7.450
Authors: A Bamias; Ch Deliveliotis; G Fountzilas; D Gika; A Anagnostopoulos; M P Zorzou; E Kastritis; C Constantinides; P Kosmidis; M A Dimopoulos Journal: J Clin Oncol Date: 2004-06-01 Impact factor: 44.544
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: Vitaly Margulis; Maneka Puligandla; Edouard J Trabulsi; Elizabeth R Plimack; Elizabeth R Kessler; Surena F Matin; Guilherme Godoy; Ajjai Alva; Noah M Hahn; Michael A Carducci; Jean Hoffman-Censits Journal: J Urol Date: 2019-11-08 Impact factor: 7.450
Authors: Byron H Lee; Emily C Zabor; Daniel Tennenbaum; Helena Furberg; Nicole Benfante; Jonathan A Coleman; Edgar A Jaimes; Paul Russo Journal: World J Urol Date: 2017-12-05 Impact factor: 4.226
Authors: Aurélie Mbeutcha; Ilaria Lucca; Vitaly Margulis; Jose A Karam; Christopher G Wood; Michela de Martino; Romain Mathieu; Andrea Haitel; Evanguelos Xylinas; Luis Kluth; Morgan Rouprêt; Pierre I Karakiewicz; Alberto Briganti; Michael Rink; Malte Rieken; Alon Z Weizer; Jay D Raman; Nathalie Rioux-Leclecq; Christian Bolenz; Karim Bensalah; Yair Lotan; Christian Seitz; Mesut Remzi; Shahrokh F Shariat; Tobias Klatte Journal: World J Urol Date: 2015-12-11 Impact factor: 4.226