Suguru Shirotake1, Eiji Kikuchi2, Nobuyuki Tanaka1, Kazuhiro Matsumoto1, Yasumasa Miyazaki1, Hiroaki Kobayashi1, Hiroki Ide1, Jun Obata1, Katsura Hoshino1, Gou Kaneko1, Masayuki Hagiwara1, Takeo Kosaka1, Kent Kanao1, Kiichiro Kodaira1, Satoshi Hara1, Masafumi Oyama1, Tetsuo Momma1, Akira Miyajima1, Ken Nakagawa1, Shintaro Hasegawa1, Yosuke Nakajima1, Mototsugu Oya1. 1. Department of Urology, Keio University School of Medicine (SS, EK, NT, KM, YM, HK, HI, JO, KH, GK, MH, TK, KK, AM, MO), Tokyo, Japan; Saiseikai Central Hospital (KM), Tokyo, Japan; Kyosai Tachikawa Hospital (HK), Tokyo, Japan; Kawasaki City Hospital (GK, SH), Tokyo, Japan; Musashino Yowakai Hospital (NT), Tokyo, Japan; Ogikubo Hospital (YM), Tokyo, Japan; Inagi City Hospital (HI), Tokyo, Japan; International Medical Center-Comprehensive Cancer Center, Saitama Medical University (SS, KK, MO), Saitama, Japan; Saitama City Hospital (NT), Saitama, Japan; National Hospital Organization Saitama Hospital (TM), Saitama, Japan; Irumagawa Hospital (TK), Saitama, Japan; National Hospital Organization Tochigi Medical Center, Tochigi (SH), Japan; Saiseikai Yokohamashi Tobu Hospital, Kanagawa (YN), Japan; Ichikawa General Hospital, Tokyo Dental College, Chiba (MH, KN), Japan. 2. Department of Urology, Keio University School of Medicine (SS, EK, NT, KM, YM, HK, HI, JO, KH, GK, MH, TK, KK, AM, MO), Tokyo, Japan; Saiseikai Central Hospital (KM), Tokyo, Japan; Kyosai Tachikawa Hospital (HK), Tokyo, Japan; Kawasaki City Hospital (GK, SH), Tokyo, Japan; Musashino Yowakai Hospital (NT), Tokyo, Japan; Ogikubo Hospital (YM), Tokyo, Japan; Inagi City Hospital (HI), Tokyo, Japan; International Medical Center-Comprehensive Cancer Center, Saitama Medical University (SS, KK, MO), Saitama, Japan; Saitama City Hospital (NT), Saitama, Japan; National Hospital Organization Saitama Hospital (TM), Saitama, Japan; Irumagawa Hospital (TK), Saitama, Japan; National Hospital Organization Tochigi Medical Center, Tochigi (SH), Japan; Saiseikai Yokohamashi Tobu Hospital, Kanagawa (YN), Japan; Ichikawa General Hospital, Tokyo Dental College, Chiba (MH, KN), Japan. Electronic address: eiji-k@kb3.so-net.ne.jp.
Abstract
PURPOSE: Current guidelines do not yet provide any recommendations for adjuvant chemotherapy in patients with upper tract urothelial carcinoma managed with radical nephroureterectomy. We evaluated whether an adjuvant chemotherapeutic regimen would affect the clinical outcome in patients with high risk upper tract urothelial carcinoma. MATERIALS AND METHODS: We identified 873 patients who had undergone radical nephrouretectomy for localized upper tract urothelial carcinoma at 14 Japanese institutions between 1993 and 2011. We assessed whether the type of regimen, such as methotrexate, vinblastine, doxorubicin and cisplatin, and gemcitabine and cisplatin, in an adjuvant setting, could affect the subsequent clinical outcome of patients with upper tract urothelial carcinoma. RESULTS: On multivariate analysis pathological T stage, tumor grade, lymphovascular invasion and lymph node involvement were prognostic factors for recurrence-free survival and cancer specific survival. We defined 229 patients with 3 or more of these factors as the high risk group. In an analysis according to adjuvant regimen, Kaplan-Meier curves showed that the 1 and 2-year recurrence-free survival rates in the methotrexate, vinblastine, doxorubicin and cisplatin treated group were 71.4% and 47.9%, which were significantly higher than in the gemcitabine and cisplatin treated group (48.2% and not reached, p=0.022) or those not treated with adjuvant chemotherapy (53.4% and 39.6%, p=0.039). Similar results were observed in terms of cancer specific survival. CONCLUSIONS: Our study showed that pT3-4, tumor grade 3, positive lymphovascular invasion and lymph node involvement were independent risk factors for disease mortality in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy. In the high risk group methotrexate, vinblastine, doxorubicin and cisplatin adjuvant chemotherapy contributed to improve subsequent mortality compared to gemcitabine and cisplatin or no adjuvant chemotherapy.
PURPOSE: Current guidelines do not yet provide any recommendations for adjuvant chemotherapy in patients with upper tract urothelial carcinoma managed with radical nephroureterectomy. We evaluated whether an adjuvant chemotherapeutic regimen would affect the clinical outcome in patients with high risk upper tract urothelial carcinoma. MATERIALS AND METHODS: We identified 873 patients who had undergone radical nephrouretectomy for localized upper tract urothelial carcinoma at 14 Japanese institutions between 1993 and 2011. We assessed whether the type of regimen, such as methotrexate, vinblastine, doxorubicin and cisplatin, and gemcitabine and cisplatin, in an adjuvant setting, could affect the subsequent clinical outcome of patients with upper tract urothelial carcinoma. RESULTS: On multivariate analysis pathological T stage, tumor grade, lymphovascular invasion and lymph node involvement were prognostic factors for recurrence-free survival and cancer specific survival. We defined 229 patients with 3 or more of these factors as the high risk group. In an analysis according to adjuvant regimen, Kaplan-Meier curves showed that the 1 and 2-year recurrence-free survival rates in the methotrexate, vinblastine, doxorubicin and cisplatin treated group were 71.4% and 47.9%, which were significantly higher than in the gemcitabine and cisplatin treated group (48.2% and not reached, p=0.022) or those not treated with adjuvant chemotherapy (53.4% and 39.6%, p=0.039). Similar results were observed in terms of cancer specific survival. CONCLUSIONS: Our study showed that pT3-4, tumor grade 3, positive lymphovascular invasion and lymph node involvement were independent risk factors for disease mortality in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy. In the high risk group methotrexate, vinblastine, doxorubicin and cisplatin adjuvant chemotherapy contributed to improve subsequent mortality compared to gemcitabine and cisplatin or no adjuvant chemotherapy.
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