Beat Foerster1,2, Mohammad Abufaraj1,3, Firas Petros4, Mounsif Azizi5, Mohit Gupta6, Donald Schweitzer7, Vitaly Margulis8, Takehiro Iwata1,9, Shoji Kimura1,10, Ahmad Shabsigh11, Alberto Briganti12, Ja H Ku13, Tim Muilwijk14, Wassim Kassouf15, Surena F Matin4, Philippe E Spiess5, Phillip M Pierorazio6, Kees Hendricksen7, Shahrokh F Shariat1,16,8,17,18,19. 1. Department of Urology, Medical University of Vienna, Vienna, Austria. 2. Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland. 3. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan. 4. Department of Urology, MD Anderson Cancer Center, Houston, Texas. 5. Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida. 6. Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, Maryland. 7. Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 8. Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas. 9. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 10. Department of Urology, Jikei University School of Medicine, Tokyo, Japan. 11. Department of Urology, Ohio State University, Columbus, Ohio. 12. Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy. 13. Department of Urology, Seoul National University Hospital, Seoul, Korea. 14. Department of Urology, University Hospitals Leuven, Leuven, Belgium. 15. Department of Surgery, Division of Urology, McGill University Health Center, Montreal, Canada. 16. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. 17. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. 18. Department of Urology, Weill Cornell Medical College, New York, New York. 19. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
Abstract
PURPOSE: The impact of preoperative chemotherapy in patients with upper urinary tract urothelial carcinoma remains poorly investigated. We assessed the rates of pathological complete response (pT0N0/X) and downstaging (pT1N0/X or less) at radical nephroureterectomy after preoperative chemotherapy and evaluated their impact on survival. MATERIALS AND METHODS: This was an international observational study of patients who underwent preoperative chemotherapy and radical nephroureterectomy for high risk upper tract urothelial carcinoma between 2005 and 2017. Multiple imputation of chained equations was applied to account for missing values. Logistic regression analyses were performed to identify predictors of pathological response. Cox proportional hazard regression models were used to estimate recurrence-free survival, cancer specific survival and overall survival. RESULTS: A total of 267 patients met our inclusion criteria. Among included patients 82 (31%) received methotrexate, vinblastine, doxorubicin and cisplatin; 123 (46%) gemcitabine and cisplatin; 25 (9%) gemcitabine and carboplatin; and 32 (12%) other regimens. The overall rates of pathological complete response and pathological downstaging were 10.1% and 44.9%, respectively. On multivariable analysis the use of gemcitabine and cisplatin, and gemcitabine and carboplatin was not statistically different from methotrexate, vinblastine, doxorubicin and cisplatin in achieving pathological complete response and pathological downstaging, respectively. The number of administered cycles did not appear to have an effect on pathological responses. Pathological downstaging was the strongest prognostic factor for recurrence-free survival (HR 0.2, p <0.001), cancer specific survival (HR 0.19, p <0.001) and overall survival (HR 0.40, p <0.001). CONCLUSIONS: Pathological downstaging after preoperative chemotherapy is a robust prognostic factor at radical nephroureterectomy and is associated with improved survival outcomes. Although preoperative chemotherapy appears to be effective, well designed prospective studies are still needed.
PURPOSE: The impact of preoperative chemotherapy in patients with upper urinary tract urothelial carcinoma remains poorly investigated. We assessed the rates of pathological complete response (pT0N0/X) and downstaging (pT1N0/X or less) at radical nephroureterectomy after preoperative chemotherapy and evaluated their impact on survival. MATERIALS AND METHODS: This was an international observational study of patients who underwent preoperative chemotherapy and radical nephroureterectomy for high risk upper tract urothelial carcinoma between 2005 and 2017. Multiple imputation of chained equations was applied to account for missing values. Logistic regression analyses were performed to identify predictors of pathological response. Cox proportional hazard regression models were used to estimate recurrence-free survival, cancer specific survival and overall survival. RESULTS: A total of 267 patients met our inclusion criteria. Among included patients 82 (31%) received methotrexate, vinblastine, doxorubicin and cisplatin; 123 (46%) gemcitabine and cisplatin; 25 (9%) gemcitabine and carboplatin; and 32 (12%) other regimens. The overall rates of pathological complete response and pathological downstaging were 10.1% and 44.9%, respectively. On multivariable analysis the use of gemcitabine and cisplatin, and gemcitabine and carboplatin was not statistically different from methotrexate, vinblastine, doxorubicin and cisplatin in achieving pathological complete response and pathological downstaging, respectively. The number of administered cycles did not appear to have an effect on pathological responses. Pathological downstaging was the strongest prognostic factor for recurrence-free survival (HR 0.2, p <0.001), cancer specific survival (HR 0.19, p <0.001) and overall survival (HR 0.40, p <0.001). CONCLUSIONS: Pathological downstaging after preoperative chemotherapy is a robust prognostic factor at radical nephroureterectomy and is associated with improved survival outcomes. Although preoperative chemotherapy appears to be effective, well designed prospective studies are still needed.
Authors: Omar Alhalabi; Matthew T Campbell; Lianchun Xiao; Ana C Adriazola; Nathaniel R Wilson; Arlene O Siefker-Radtke; Paul G Corn; Amado Zurita; Eric Jonasch; Jianjun Gao; Mehrad Adibi; Ashish M Kamat; Neema Navai; Louis L Pisters; Colin Dinney; Surena F Matin; Amishi Y Shah Journal: BJUI Compass Date: 2021-10-11
Authors: Gianluigi Califano; Idir Ouzaid; Paul Laine-Caroff; Arthur Peyrottes; Claudia Collà Ruvolo; Benjamin Pradère; Vincent Elalouf; Vincent Misrai; Jean-François Hermieu; Shahrokh F Shariat; Evanguelos Xylinas Journal: Curr Oncol Date: 2022-01-29 Impact factor: 3.677
Authors: Benjamin Pradere; David D'Andrea; Victor M Schuettfort; Beat Foerster; Fahad Quhal; Keiichiro Mori; Mohammad Abufaraj; Vitaly Margulis; Marine Deuker; Alberto Briganti; Tim Muilwijk; Kees Hendricksen; Yair Lotan; Pierre Karakiewic; Shahrokh F Shariat Journal: World J Urol Date: 2020-10-16 Impact factor: 4.226