The role of adjuvant chemotherapy for lymph node-positive upper tract urothelial carcinoma following radical nephroureterectomy: A retrospective study

Ilaria Lucca, Wassim Kassouf, Anil Kapoor, Adrian Fairey, Ricardo A. Rendon, Jonathan I. Izawa, Peter C. Black, Harun Fajkovic, Christian Seitz, Mesut Remzi, Peter Nyirády, Morgan Rouprêt, Vitaly Margulis, Yair Lotan, Michela De Martino, Sebastian L. Hofbauer, Pierre I. Karakiewicz, Alberto Briganti, Giacomo Novara, Shahrokh F. ShariatTobias Klatte

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Abstract

Objective To evaluate the effect of adjuvant chemotherapy (AC) on mortality after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) with positive lymph nodes (LNs) and to identify patient subgroups that are most likely to benefit from AC. Patients and methods We retrospectively analysed data of 263 patients with LN-positive UTUC, who underwent full surgical resection. In all, 107 patients (41%) received three to six cycles of AC, while 156 (59.3%) were treated with RNU alone. UTUC-related mortality was evaluated using competing-risks regression models. Results In all patients (T<inf>all</inf> N+), administration of AC had no significant impact on UTUC-related mortality on univariable (P = 0.49) and multivariable (P = 0.11) analysis. Further stratified analyses showed that only N+ patients with pT3-4 disease benefited from AC. In this subgroup, AC reduced UTUC-related mortality by 34% (P = 0.019). The absolute difference in mortality was 10% after the first year and increased to 23% after 5 years. On multivariable analysis, administration of AC was associated with significantly reduced UTUC-related mortality (subhazard ratio 0.67, P = 0.022). Limitations of this study are the retrospective non-randomised design, selection bias, absence of a central pathological review and different AC protocols. Conclusions AC seems to reduce mortality in patients with pT3-4 LN-positive UTUC after RNU. This subgroup of LN-positive patients could serve as target population for an AC prospective randomised trial.

Original languageEnglish (US)
Pages (from-to)72-78
Number of pages7
JournalBJU International
Volume116
Issue number1
DOIs
StatePublished - Jul 1 2015

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Adjuvant Chemotherapy
Retrospective Studies
Lymph Nodes
Carcinoma
Mortality
Selection Bias
Health Services Needs and Demand

Keywords

  • adjuvant chemotherapy
  • lymph node positive
  • radical nephroureterectomy
  • survival
  • upper tract urothelial carcinoma

ASJC Scopus subject areas

  • Urology

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The role of adjuvant chemotherapy for lymph node-positive upper tract urothelial carcinoma following radical nephroureterectomy : A retrospective study. / Lucca, Ilaria; Kassouf, Wassim; Kapoor, Anil; Fairey, Adrian; Rendon, Ricardo A.; Izawa, Jonathan I.; Black, Peter C.; Fajkovic, Harun; Seitz, Christian; Remzi, Mesut; Nyirády, Peter; Rouprêt, Morgan; Margulis, Vitaly; Lotan, Yair; De Martino, Michela; Hofbauer, Sebastian L.; Karakiewicz, Pierre I.; Briganti, Alberto; Novara, Giacomo; Shariat, Shahrokh F.; Klatte, Tobias.

In: BJU International, Vol. 116, No. 1, 01.07.2015, p. 72-78.

Research output: Contribution to journalArticle

Lucca, I, Kassouf, W, Kapoor, A, Fairey, A, Rendon, RA, Izawa, JI, Black, PC, Fajkovic, H, Seitz, C, Remzi, M, Nyirády, P, Rouprêt, M, Margulis, V, Lotan, Y, De Martino, M, Hofbauer, SL, Karakiewicz, PI, Briganti, A, Novara, G, Shariat, SF & Klatte, T 2015, 'The role of adjuvant chemotherapy for lymph node-positive upper tract urothelial carcinoma following radical nephroureterectomy: A retrospective study', BJU International, vol. 116, no. 1, pp. 72-78. https://doi.org/10.1111/bju.12801
Lucca, Ilaria ; Kassouf, Wassim ; Kapoor, Anil ; Fairey, Adrian ; Rendon, Ricardo A. ; Izawa, Jonathan I. ; Black, Peter C. ; Fajkovic, Harun ; Seitz, Christian ; Remzi, Mesut ; Nyirády, Peter ; Rouprêt, Morgan ; Margulis, Vitaly ; Lotan, Yair ; De Martino, Michela ; Hofbauer, Sebastian L. ; Karakiewicz, Pierre I. ; Briganti, Alberto ; Novara, Giacomo ; Shariat, Shahrokh F. ; Klatte, Tobias. / The role of adjuvant chemotherapy for lymph node-positive upper tract urothelial carcinoma following radical nephroureterectomy : A retrospective study. In: BJU International. 2015 ; Vol. 116, No. 1. pp. 72-78.
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abstract = "Objective To evaluate the effect of adjuvant chemotherapy (AC) on mortality after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) with positive lymph nodes (LNs) and to identify patient subgroups that are most likely to benefit from AC. Patients and methods We retrospectively analysed data of 263 patients with LN-positive UTUC, who underwent full surgical resection. In all, 107 patients (41{\%}) received three to six cycles of AC, while 156 (59.3{\%}) were treated with RNU alone. UTUC-related mortality was evaluated using competing-risks regression models. Results In all patients (Tall N+), administration of AC had no significant impact on UTUC-related mortality on univariable (P = 0.49) and multivariable (P = 0.11) analysis. Further stratified analyses showed that only N+ patients with pT3-4 disease benefited from AC. In this subgroup, AC reduced UTUC-related mortality by 34{\%} (P = 0.019). The absolute difference in mortality was 10{\%} after the first year and increased to 23{\%} after 5 years. On multivariable analysis, administration of AC was associated with significantly reduced UTUC-related mortality (subhazard ratio 0.67, P = 0.022). Limitations of this study are the retrospective non-randomised design, selection bias, absence of a central pathological review and different AC protocols. Conclusions AC seems to reduce mortality in patients with pT3-4 LN-positive UTUC after RNU. This subgroup of LN-positive patients could serve as target population for an AC prospective randomised trial.",
keywords = "adjuvant chemotherapy, lymph node positive, radical nephroureterectomy, survival, upper tract urothelial carcinoma",
author = "Ilaria Lucca and Wassim Kassouf and Anil Kapoor and Adrian Fairey and Rendon, {Ricardo A.} and Izawa, {Jonathan I.} and Black, {Peter C.} and Harun Fajkovic and Christian Seitz and Mesut Remzi and Peter Nyir{\'a}dy and Morgan Roupr{\^e}t and Vitaly Margulis and Yair Lotan and {De Martino}, Michela and Hofbauer, {Sebastian L.} and Karakiewicz, {Pierre I.} and Alberto Briganti and Giacomo Novara and Shariat, {Shahrokh F.} and Tobias Klatte",
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TY - JOUR

T1 - The role of adjuvant chemotherapy for lymph node-positive upper tract urothelial carcinoma following radical nephroureterectomy

T2 - A retrospective study

AU - Lucca, Ilaria

AU - Kassouf, Wassim

AU - Kapoor, Anil

AU - Fairey, Adrian

AU - Rendon, Ricardo A.

AU - Izawa, Jonathan I.

AU - Black, Peter C.

AU - Fajkovic, Harun

AU - Seitz, Christian

AU - Remzi, Mesut

AU - Nyirády, Peter

AU - Rouprêt, Morgan

AU - Margulis, Vitaly

AU - Lotan, Yair

AU - De Martino, Michela

AU - Hofbauer, Sebastian L.

AU - Karakiewicz, Pierre I.

AU - Briganti, Alberto

AU - Novara, Giacomo

AU - Shariat, Shahrokh F.

AU - Klatte, Tobias

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Objective To evaluate the effect of adjuvant chemotherapy (AC) on mortality after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) with positive lymph nodes (LNs) and to identify patient subgroups that are most likely to benefit from AC. Patients and methods We retrospectively analysed data of 263 patients with LN-positive UTUC, who underwent full surgical resection. In all, 107 patients (41%) received three to six cycles of AC, while 156 (59.3%) were treated with RNU alone. UTUC-related mortality was evaluated using competing-risks regression models. Results In all patients (Tall N+), administration of AC had no significant impact on UTUC-related mortality on univariable (P = 0.49) and multivariable (P = 0.11) analysis. Further stratified analyses showed that only N+ patients with pT3-4 disease benefited from AC. In this subgroup, AC reduced UTUC-related mortality by 34% (P = 0.019). The absolute difference in mortality was 10% after the first year and increased to 23% after 5 years. On multivariable analysis, administration of AC was associated with significantly reduced UTUC-related mortality (subhazard ratio 0.67, P = 0.022). Limitations of this study are the retrospective non-randomised design, selection bias, absence of a central pathological review and different AC protocols. Conclusions AC seems to reduce mortality in patients with pT3-4 LN-positive UTUC after RNU. This subgroup of LN-positive patients could serve as target population for an AC prospective randomised trial.

AB - Objective To evaluate the effect of adjuvant chemotherapy (AC) on mortality after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) with positive lymph nodes (LNs) and to identify patient subgroups that are most likely to benefit from AC. Patients and methods We retrospectively analysed data of 263 patients with LN-positive UTUC, who underwent full surgical resection. In all, 107 patients (41%) received three to six cycles of AC, while 156 (59.3%) were treated with RNU alone. UTUC-related mortality was evaluated using competing-risks regression models. Results In all patients (Tall N+), administration of AC had no significant impact on UTUC-related mortality on univariable (P = 0.49) and multivariable (P = 0.11) analysis. Further stratified analyses showed that only N+ patients with pT3-4 disease benefited from AC. In this subgroup, AC reduced UTUC-related mortality by 34% (P = 0.019). The absolute difference in mortality was 10% after the first year and increased to 23% after 5 years. On multivariable analysis, administration of AC was associated with significantly reduced UTUC-related mortality (subhazard ratio 0.67, P = 0.022). Limitations of this study are the retrospective non-randomised design, selection bias, absence of a central pathological review and different AC protocols. Conclusions AC seems to reduce mortality in patients with pT3-4 LN-positive UTUC after RNU. This subgroup of LN-positive patients could serve as target population for an AC prospective randomised trial.

KW - adjuvant chemotherapy

KW - lymph node positive

KW - radical nephroureterectomy

KW - survival

KW - upper tract urothelial carcinoma

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