Yun-Ching Huang1, Miao-Fen Chen2, Chung-Sheng Shi3, Alan W Shindel4, Cih-En Huang5, See-Tong Pang6, Cheng-Keng Chuang6, Chih-Shou Chen7, Ying-Hsu Chang6, Wei-Yu Lin7, Dong-Ru Ho7, Chih-Chien Chin8, Yi-Hung Kuo8, Ching-Fang Wu9. 1. Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: chrishyc@gmail.com. 2. Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan. 3. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. 4. Department of Urology, University of California, Davis, California. 5. Department of Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan. 6. Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. 7. Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan. 8. Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan. 9. Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan. Electronic address: wuchingf@ms3.hinet.net.
Abstract
PURPOSE: Nephroureterectomy with bladder cuff excision may not be sufficient as monotherapy for patients with pT3N0M0 upper tract urothelial carcinoma. The efficacy of postoperative adjuvant chemotherapy in this setting remains controversial. We evaluated the efficacy of adjuvant chemotherapy for patients with pT3N0M0 upper tract urothelial carcinoma in overall, cancer specific and recurrence-free survival. MATERIALS AND METHODS: We retrospectively reviewed records on 171 consecutive patients with pT3N0M0 upper tract urothelial carcinoma treated with radical nephroureterectomy between 2004 and 2014 at 2 branches of the same institution. Postoperative adjuvant chemotherapy was gemcitabine/cisplatin or cisplatin/fluorouracil/leucovorin. Overall, cancer specific and recurrence-free survival rates were estimated using the Kaplan-Meier method. The values of prognostic factors were evaluated by Cox regression analysis. RESULTS: Postoperative adjuvant chemotherapy was administered in 60 patients vs nonadjuvant therapy in 111 patients. Median followup was 35.8 months. Between the adjuvant and nonadjuvant treatment groups there were statistically significant differences in 5-year cancer specific (80.5% vs 57.6%, p = 0.010) and recurrence-free (74.4% vs 52.9%, p = 0.026) survival rates. Although there was no statistically significant difference in overall survival (71.9% vs 49.0%, p = 0.072), there was a trend of better overall survival in the patients who received postoperative chemotherapy. On multivariable analysis age (p = 0.018), tumor location (p = 0.003) and adjuvant chemotherapy (p = 0.001) were predictors of cancer specific survival. CONCLUSIONS: Adjuvant chemotherapy improves cancer specific and recurrence-free survival in patients with pT3N0M0 upper tract urothelial carcinoma after radical nephroureterectomy.
PURPOSE: Nephroureterectomy with bladder cuff excision may not be sufficient as monotherapy for patients with pT3N0M0 upper tract urothelial carcinoma. The efficacy of postoperative adjuvant chemotherapy in this setting remains controversial. We evaluated the efficacy of adjuvant chemotherapy for patients with pT3N0M0 upper tract urothelial carcinoma in overall, cancer specific and recurrence-free survival. MATERIALS AND METHODS: We retrospectively reviewed records on 171 consecutive patients with pT3N0M0 upper tract urothelial carcinoma treated with radical nephroureterectomy between 2004 and 2014 at 2 branches of the same institution. Postoperative adjuvant chemotherapy was gemcitabine/cisplatin or cisplatin/fluorouracil/leucovorin. Overall, cancer specific and recurrence-free survival rates were estimated using the Kaplan-Meier method. The values of prognostic factors were evaluated by Cox regression analysis. RESULTS: Postoperative adjuvant chemotherapy was administered in 60 patients vs nonadjuvant therapy in 111 patients. Median followup was 35.8 months. Between the adjuvant and nonadjuvant treatment groups there were statistically significant differences in 5-year cancer specific (80.5% vs 57.6%, p = 0.010) and recurrence-free (74.4% vs 52.9%, p = 0.026) survival rates. Although there was no statistically significant difference in overall survival (71.9% vs 49.0%, p = 0.072), there was a trend of better overall survival in the patients who received postoperative chemotherapy. On multivariable analysis age (p = 0.018), tumor location (p = 0.003) and adjuvant chemotherapy (p = 0.001) were predictors of cancer specific survival. CONCLUSIONS: Adjuvant chemotherapy improves cancer specific and recurrence-free survival in patients with pT3N0M0 upper tract urothelial carcinoma after radical nephroureterectomy.
Authors: Matthew R Danzig; Katherine Mallin; James M McKiernan; Walter M Stadler; Srikala S Sridhar; Todd M Morgan; Bernard H Bochner; Cheryl T Lee Journal: Cancer Date: 2018-04-06 Impact factor: 6.860
Authors: Georgios Gakis; Tina Schubert; Mehrdad Alemozaffar; Joaquim Bellmunt; Bernard H Bochner; Steven A Boorjian; Siamak Daneshmand; William C Huang; Tsunenori Kondo; Badrinath R Konety; Maria Pilar Laguna; Surena F Matin; Arlene O Siefker-Radtke; Shahrokh F Shariat; Arnulf Stenzl Journal: World J Urol Date: 2016-04-04 Impact factor: 4.226