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 language | English (US) |
|---|---|
| Pages (from-to) | 72-78 |
| Number of pages | 7 |
| Journal | BJU International |
| Volume | 116 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jul 1 2015 |
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Keywords
- adjuvant chemotherapy
- lymph node positive
- radical nephroureterectomy
- survival
- upper tract urothelial carcinoma
ASJC Scopus subject areas
- Urology
Cite this
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 journal › Article
}
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
UR - http://www.scopus.com/inward/record.url?scp=84933677810&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84933677810&partnerID=8YFLogxK
U2 - 10.1111/bju.12801
DO - 10.1111/bju.12801
M3 - Article
C2 - 24825476
AN - SCOPUS:84933677810
VL - 116
SP - 72
EP - 78
JO - BJU International
JF - BJU International
SN - 1464-4096
IS - 1
ER -