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Tuderti G, Mastroianni R, Proietti F, Wu Z, Wang L, Franco A, Abdollah F, Finati M, Ferro M, Tozzi M, Porpiglia F, Checcucci E, Bhanvadia R, Margulis V, Bronimann S, Singla N, Hakimi K, Derweesh IH, Correa A, Helstrom E, Mendiola DF, Gonzalgo ML, David RB, Mehrazin R, Moon SC, Rais-Bahrami S, Yong C, Sundaram CP, Tufano A, Perdonà S, Ghoreifi A, Moghaddam FS, Djaladat H, Ditonno F, Antonelli A, Autorino R, Simone G. Role of neoadjuvant chemotherapy in patients with locally advanced and clinically positive nodes Upper Tract Urothelial Carcinoma treated with Nephroureterectomy: real-world data from the ROBUUST 2.0 Registry. World J Urol 2024; 42:575. [PMID: 39395052 DOI: 10.1007/s00345-024-05267-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 09/09/2024] [Indexed: 10/14/2024] Open
Abstract
PURPOSE To assess the impact of neoadjuvant and adjuvant chemotherapy on survival outcomes, within a large multicenter cohort of Upper tract urothelial carcinoma patients treated with Nephroureterectomy. METHODS A multicenter retrospective analysis utilizing the Robotic surgery for Upper Tract Urothelial Cancer Study registry was performed. Baseline, preoperative, perioperative, and pathologic variables of three groups of patients receiving surgery only, neoadjuvant or adjuvant chemotherapy were compared. Categorical and continuous variables among the three subgroups were compared with Chi square and ANOVA tests. The impact of perioperative chemotherapy on survival outcomes was assessed with the Kaplan Meier method. Univariable and multivariable Cox regression analyses were performed to identify predictors of survival. RESULTS Overall, 1,994 patients were included. Overall and Clavien grade ≥3 complications rates were comparable among the three subgroups (p = 0.65 and p = 0.92). At Kaplan Meier analysis, neoadjuvant chemotherapy significantly improved cancer-specific survival (p = 0.03) and overall survival (p = 0.03) probabilities of patients with cT ≥ 3 tumors and of those with positive cN (p = 0.03 and p = 0.02). On multivariable analysis, neoadjuvant chemotherapy was independently associated with an improvement of cancer-specific survival in cT ≥ 3 patients (HR 0.44; p = 0.04), and of both cancer-specific survival (HR 0.50; p = 0.03) and overall survival (HR 0.53; p = 0.02) probabilities in positive cN patients. CONCLUSIONS This large multicenter retrospective analysis suggests significant survival benefit in Upper tract urothelial carcinoma patients with either locally advanced or clinically positive nodes disease receiving neoadjuvant chemotherapy. These findings can be regarded as "hypothesis generating", stimulating future trials focusing on such advanced stages.
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Affiliation(s)
- Gabriele Tuderti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy.
| | - Riccardo Mastroianni
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
| | - Flavia Proietti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Linhui Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Marco Finati
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy
| | - Marco Tozzi
- Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy
| | - Francesco Porpiglia
- Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Raj Bhanvadia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Stephan Bronimann
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nirmish Singla
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin Hakimi
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Andreas Correa
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Emma Helstrom
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Dinno F Mendiola
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark L Gonzalgo
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Reuben Ben David
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sol C Moon
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Courtney Yong
- Department of Urology, Indiana University, Indianapolis, IN, USA
| | | | - Antonio Tufano
- Uro-Gynecological Department, Fondazione "G. Pascale" IRCCS, Naples, Italy
| | - Sisto Perdonà
- Uro-Gynecological Department, Fondazione "G. Pascale" IRCCS, Naples, Italy
| | - Alireza Ghoreifi
- Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, USA
| | - Farshad S Moghaddam
- Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, USA
| | - Hooman Djaladat
- Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, USA
| | | | | | | | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
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Quan P, Zhang L, Yang B, Hou H, Wu N, Fan X, Yu C, Zhu H, Feng T, Zhang Y, Qu K, Yang X. Effectiveness and safety of adjuvant treatment of tislelizumab with or without chemotherapy in patients with high-risk upper tract urothelial carcinoma: a retrospective, real-world study. Clin Transl Oncol 2024:10.1007/s12094-024-03659-2. [PMID: 39172333 DOI: 10.1007/s12094-024-03659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/30/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Upper tract urothelial carcinoma (UTUC) is a rare subset of urothelial cancers with poor prognosis. No consensus exists on the benefit of adjuvant immunotherapy for patients with UTUCs after nephroureterectomy with curative intent and the existing studies are limited. Herein, this study aimed to evaluate the effectiveness and safety of adjuvant treatment of tislelizumab with or without chemotherapy in patients with high-risk UTUC. METHODS A retrospective study was conducted on 63 patients with high-risk UTUC who received tislelizumab with or without gemcitabine-cisplatin (GC) chemotherapy regimen after surgery between January 2020 and December 2022. Data on demographic and clinical characteristics, surgical, outcomes, prognostic factors, and safety were collected and analyzed. RESULTS Among the 63 patients with high-risk UTUC, the median age was 66 years (interquartile range 57-72), with 33 (52%) being male. The majority of patients with staged pT3 (44%) and pN0 (78%) disease. Fifty-one patients (81%) received tislelizumab plus GC chemotherapy, and 12 (19%) were treated with tislelizumab monotherapy. After the median follow-up of 26 months (range 1-47), 49 (78%) patients achieved stable disease. The 2-year disease-free survival (DFS) and 2-year overall survival were 78.68% (95% CI: 60.02-87.07%) and 81.40% (95% CI: 68.76-89.31%), respectively. The cycles of GC chemotherapy were independent prognostic factors for survival, with higher DFS (hazard ratio = 0.68, 95% CI, 0.50-0.93; p = 0.016) observed in the subgroup undergoing ≥ 3 cycles versus < 3 cycles of GC chemotherapy. Fifty-eight patients (92%) experienced at least one treatment-related adverse event (TRAE), with grade 3-4 TRAEs occurring in 13%. The most common grade 3-4 TRAEs were decreased white blood cells, thrombocytopenia, and ulcers. CONCLUSIONS The study demonstrates promising clinical benefits and a manageable safety profile of the tislelizumab-based adjuvant regimen for patients with high-risk UTUC. This suggests that adjuvant immunotherapy represents a potential therapeutic strategy for this population.
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Affiliation(s)
- Penghe Quan
- Department of Urology, Xijing Hospital of Air Force Military Medical University, No. 127, Changle West Road, Xincheng District, Xi'an, 710032, China
| | - Longlong Zhang
- Department of Urology, Xijing Hospital of Air Force Military Medical University, No. 127, Changle West Road, Xincheng District, Xi'an, 710032, China
| | - Bo Yang
- Department of Urology, The 986 Hospital of the Air Force Military Medical University, Xi'an, 710054, China
| | - Haozhong Hou
- Department of Urology, Xijing Hospital of Air Force Military Medical University, No. 127, Changle West Road, Xincheng District, Xi'an, 710032, China
| | - Ningli Wu
- Department of Pharmacy, The First Hospital of Xi'an, Xi'an, 710002, China
| | - Xiaozheng Fan
- Department of Urology, Xijing Hospital of Air Force Military Medical University, No. 127, Changle West Road, Xincheng District, Xi'an, 710032, China
| | - Changjiang Yu
- Department of Urology, Xijing Hospital of Air Force Military Medical University, No. 127, Changle West Road, Xincheng District, Xi'an, 710032, China
| | - He Zhu
- Department of Urology, Xijing Hospital of Air Force Military Medical University, No. 127, Changle West Road, Xincheng District, Xi'an, 710032, China
| | - Tianxi Feng
- Department of Urology, Xijing Hospital of Air Force Military Medical University, No. 127, Changle West Road, Xincheng District, Xi'an, 710032, China
| | - Yifan Zhang
- Department of Urology, Xijing Hospital of Air Force Military Medical University, No. 127, Changle West Road, Xincheng District, Xi'an, 710032, China
| | - Kejun Qu
- Department of Urology, Xijing Hospital of Air Force Military Medical University, No. 127, Changle West Road, Xincheng District, Xi'an, 710032, China
| | - Xiaojian Yang
- Department of Urology, Xijing Hospital of Air Force Military Medical University, No. 127, Changle West Road, Xincheng District, Xi'an, 710032, China.
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Pinar U, Calleris G, Grobet-Jeandin E, Grande P, Benamran D, Thibault C, Gontero P, Rouprêt M, Seisen T. The role of perioperative chemotherapy for upper tract urothelial carcinoma patients treated with radical nephroureterectomy. World J Urol 2023; 41:3205-3230. [PMID: 36905443 DOI: 10.1007/s00345-023-04330-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/05/2023] [Indexed: 03/12/2023] Open
Abstract
PURPOSE To summarize evidence regarding the use of neoadjuvant (NAC) and adjuvant chemotherapy (AC) among patients treated with radical nephroureterectomy (RNU). METHODS A comprehensive literature search of PubMed (MEDLINE), EMBASE and the Cochrane library was performed to identify any original or review article on the role of perioperative chemotherapy for UTUC patients treated with RNU. RESULTS With regards to NAC, retrospective studies consistently suggested that it may be associated with better pathological downstaging (pDS) ranging from 10.8 to 80% and complete response (pCR) ranging from 4.3 to 15%, while decreasing the risk of recurrence and death as compared to RNU alone. Even higher pDS ranging from 58 to 75% and pCR ranging from 14 to 38% were observed in single-arm phase II trials. With regards to AC, retrospective studies provided conflicting results although the largest report from the National Cancer Database suggested an overall survival benefit in pT3-T4 and/or pN + patients. In addition, a phase III randomized controlled trial showed that the use of AC was associated with a disease-free survival benefit (HR = 0.45; 95% CI = [0.30-0.68]; p = 0.0001) in pT2-T4 and/or pN + patients with acceptable toxicity profile. This benefit was consistent in all subgroups analyzed. CONCLUSIONS Perioperative chemotherapy improves oncological outcomes associated with RNU. Given the impact of RNU on renal function, the rational is stronger for the use of NAC which impacts final pathology and potentially prolongs survival. However, the level of evidence is stronger for the use of AC that has been proven to decrease the risk of recurrence after RNU with a potential survival benefit.
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Affiliation(s)
- Ugo Pinar
- GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière, Urology, Sorbonne University, 75013, Paris, France
| | - Giorgio Calleris
- Department of Urology, San Giovanni Battista Hospital, Città Della Salute E Della Scienza and University of Turin, Turin, Italy
| | | | - Pietro Grande
- GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière, Urology, Sorbonne University, 75013, Paris, France
| | - Daniel Benamran
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Constance Thibault
- Department of Medical Oncology, Hopital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP Centre, Paris, France
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, Città Della Salute E Della Scienza and University of Turin, Turin, Italy
| | - Morgan Rouprêt
- GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière, Urology, Sorbonne University, 75013, Paris, France
| | - Thomas Seisen
- GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière, Urology, Sorbonne University, 75013, Paris, France.
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Hongda Z, Kang L, Ng CF, de la Rosette J, Laguna P, Gontero P, Baard J, Yildiz O, Teoh JYC. Impact of Adjuvant Gemcitabine Containing Chemotherapy Following Radical Nephroureterectomy for Patients with Upper Tract Urothelial Carcinoma: Results from a Propensity-Score Matched Cohort Study. Bladder Cancer 2023; 9:217-226. [PMID: 38993186 PMCID: PMC11181833 DOI: 10.3233/blc-230041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/05/2023] [Indexed: 07/13/2024]
Abstract
BACKGROUND The evidence regarding perioperative adjuvant chemotherapy and personalized surveillance strategies for upper tract urothelial carcinoma is limited. OBJECTIVE To evaluate whether adjuvant gemcitabine containing chemotherapy affects the oncological outcomes of advanced upper tract urothelial carcinoma (UTUC). METHODS The CROES-UTUC registry is an observational, international, multi-center study on patients diagnosed with UTUC. Patient and disease characteristics from 2380 patients with UTUC were collected, and finally 738 patients were included in this analysis. The primary outcome of this study was recurrence-free survival. Propensity score matching was performed. Kaplan-Meier and multivariate Cox regression analyses were performed by stratifying patients according to the treatment of adjuvant chemotherapy. RESULTS A total of 738 patients were included in this analysis, and 59 patients received adjuvant chemotherapy (AC), including 50 patients who received gemcitabine. A propensity score matching was performed, including 50 patients who received gemcitabine containing treatment and 50 patients without adjuvant chemotherapy. Disease recurrence occurred in 34.0% of patients. The recurrence rate in the AC group was 22.0%, which was significantly lower than the non-AC group (46.0%). Kaplan-Meier analyses also showed that AC was associated with a lower likelihood of tumor recurrence (p = 0.047). However, AC was not significantly associated with a higher overall survival (OS) (p = 0.908) and cancer-specific survival (CSS) (p = 0.979). Upon multivariate Cox regression analysis, AC was associated with a lower risk of tumor recurrence (HR = 0.297, p = 0.028). CONCLUSION The present study confirms that adjuvant gemcitabine containing chemotherapy could decrease the risk of tumor recurrence in patients with locally advanced UTUC following nephroureterectomy. However, more studies are need to draw a clearer image of the value of this treatment method.
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Affiliation(s)
- Zhao Hongda
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Liu Kang
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Fai Ng
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Jean de la Rosette
- Department of Urology, Medipol Mega Hospital, Istanbul Medipol University, Istanbul, Turkey
| | - Pilar Laguna
- Department of Urology, Medipol Mega Hospital, Istanbul Medipol University, Istanbul, Turkey
| | - Paolo Gontero
- University of Turin, Molinette Hospital, Turin, Italy
| | - Joyce Baard
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ozcan Yildiz
- Department of Medical Oncology, Istanbul Medipol University, Istanbul, Turkey
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
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Luo Z, Jiao B, Yan Y, Su C, Pan Y, Zhao H, Bo Y, Zhang G, Ding Z. Risk factors for extraurothelial recurrence in upper tract urothelial carcinoma after radical nephroureterectomy: a retrospective study based on a Chinese population. Front Oncol 2023; 13:1164464. [PMID: 37621681 PMCID: PMC10445394 DOI: 10.3389/fonc.2023.1164464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives The risk factors for extraurothelial recurrence (EUR) after radical nephroureterectomy (RNU) in patients with upper urinary tract urothelial carcinoma (UTUC) are currently inconsistent and unclear. In this study, we aimed to identify these risk factors and develop a grading system for EUR. Methods We retrospectively analyzed 220 patients who underwent RNU for UTUC in our center from January 2009 to December 2020. Overall survival (OS) and extraurothelial recurrence-free survival (EURFS) were compared using the Kaplan-Meier curve with a log-rank test. Univariate and multivariate Cox regression models were applied to identify the independent risk factors related to EUR. Results The median follow-up period was 42 (range: 2-143) months. Of the 220 patients, 61 patients developed EUR in our cohort, which had worse survival outcome. Multivariate Cox regression analysis showed pathologic stage, lymph node (LN) status, lymphovascular invasion (LVI), Ki-67, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were independent risk factors for EUR. The Kaplan-Meier curves revealed a significant difference in EUR among the three risk groups. Conclusion Our study suggests that pathologic stage, LN status, LVI, Ki-67, NLR, and PLR are independent risk factors for EUR in UTUC patients after RNU. The development of a grading system for EUR risk stratification may assist urologists in making clinical decisions regarding the management of UTUC.
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Affiliation(s)
- Zhenkai Luo
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Binbin Jiao
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yangxuanyu Yan
- Peking University, China-Japan Friendship School Clinical Medicine, Beijing, China
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Caixia Su
- School of Public Health, Peking University, Beijing, China
| | - Yijin Pan
- Peking University, China-Japan Friendship School Clinical Medicine, Beijing, China
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Hang Zhao
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuxuan Bo
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Guan Zhang
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Zhenshan Ding
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
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Gabriel PE, Lambert T, Dumont C, Gauthier H, Masson-Lecomte A, Culine S. [Preoperative chemotherapy for patients with upper tract urothelial carcinoma: Impact on renal function]. Prog Urol 2023; 33:446-455. [PMID: 37414668 DOI: 10.1016/j.purol.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Upper tract urothelial carcinoma (UTUC) are rare tumors with a poor prognosis. The standard treatment for localized disease is based on total nephroureterectomy (NUT) followed by platinum-based adjuvant chemotherapy for eligible patients at risk of recurrence. However, many patients have renal failure after surgery preventing chemotherapy. Thus, the place of preoperative chemotherapy (POC) is questioned with little information available about renal toxicity and efficacity. METHODS A single center retrospective study was performed on patients with UTUC who received POC. RESULTS In all, 24 patients with localized UTUC were treated with POC between 2013 and 2022. Twenty-one (91%) had secondarily NUT. In this cohort, POC did not result in degradation of median renal function (pre-POC median GFR: 70mL/min, post-POC median GFR: 77mL/min, P=0.79), unlike NUT (post-NUT median GFR: 51.5mL/min, P<0.001). In addition, the rate of complete pathological response to pathological examination was 29%. After a median follow-up of 27.4 months, the overall survival rate was 74% and the recurrence-free survival rate was 46%. CONCLUSION POC for UTUC shows a very reassuring renal toxicity profile and encouraging histological results. These data encourage prospective studies assessing its place for UTUC management. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- P-E Gabriel
- Service d'oncologie médicale, hôpital Saint-Louis, AP-HP-Nord, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - T Lambert
- Service d'oncologie médicale, hôpital Saint-Louis, AP-HP-Nord, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - C Dumont
- Service d'oncologie médicale, hôpital Saint-Louis, AP-HP-Nord, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Cité, Paris, France
| | - H Gauthier
- Service d'oncologie médicale, hôpital Saint-Louis, AP-HP-Nord, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - A Masson-Lecomte
- Université Paris-Cité, Paris, France; Service d'urologie, hôpital Saint-Louis, AP-HP-Nord, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - S Culine
- Service d'oncologie médicale, hôpital Saint-Louis, AP-HP-Nord, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Cité, Paris, France.
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7
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Li X, Li H, Gao XS, Fang D, Qin S, Zhang Z, Zhou L, Li X, Wang D. Effectiveness of adjuvant radiotherapy for high recurrence risk patients with upper tract urothelial carcinoma. Urol Oncol 2022; 40:410.e1-410.e10. [DOI: 10.1016/j.urolonc.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/07/2022] [Accepted: 03/12/2022] [Indexed: 11/16/2022]
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8
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Ma R, Liu Z, Cheng Y, Zhou P, Pan Y, Bi H, Tao L, Yang B, Xia H, Zhu X, He J, He W, Wang G, Huang Y, Ma L, Lu J. Prognostic Value of Tumor Size in Patients with Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2022; 42:19-29. [PMID: 35783990 PMCID: PMC9244730 DOI: 10.1016/j.euros.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 10/25/2022] Open
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Li S, Chen X, Zheng J, Liu X. Reduced Preoperative Glomerular Filtration Rate Is Associated With Adverse Postoperative Oncological Prognosis in Patients Undergoing Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Retrospective Cohort Study. Front Surg 2022; 9:872273. [PMID: 35548184 PMCID: PMC9082599 DOI: 10.3389/fsurg.2022.872273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate the association between perioperative estimated glomerular filtration rate (eGFR) and postoperative oncological outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU),and to evaluate the effect of sex on this association. Methods The medical records of patients with UTUC who underwent RNU between January 2012 and December 2017 at our hospital were retrospectively reviewed. Patients were divided into three groups based on preoperative eGFRs: normal eGFR (>60 mL/min/1.73 m2; n = 179), moderately reduced eGFR (45-60 mL/min/1.73 m2; n = 45), and severely reduced eGFR (≤ 45 mL/min/1.73 m2; n = 36). Statistical analyses were performed to evaluate the prognostic impact of preoperative eGFR on prognosis. Results Patient mean age was 66.7 ± 9.6 years, and 47.9% were female. Multivariate regression analysis based on Cox proportional risk models and Kaplan-Meier survival rates showed that lower preoperative eGFR was associated with decreased OS, PFS, and CSS. In the adjusted Cox regression model, patients with normal and moderately reduced eGFRs had a decreased hazard for mortality, with adjusted hazard ratios of 0.13 [95% confidence interval (CI): 0.07-0.26] and 0.36 (95% CI: 0.18-0.73), respectively (P < 0.001). The smooth fitting curve suggested a linear relationship between eGFR and prognostic survival. Additionally, sensitivity subgroup analyses verified an inverse relationship between the reduced eGFR and OS. Women had a lower eGFR and worse oncological outcomes than men. A nomogram for OS was developed based on multivariate analysis with a C-index of 0.754 (95% CI: 0.728-0.779). Conclusion Preoperative renal insufficiency is strongly associated with a higher risk of cancer progression and a lower survival probability. It is important to identify preoperative renal insufficiency in patients with UTUC, particularly female patients.
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Affiliation(s)
| | | | | | - Xuefeng Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
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Ricci AD, Rizzo A, Mollica V, Schiavina R, Fiorentino M, Brunocilla E, Ardizzoni A, Massari F. Platinum-based adjuvant chemotherapy for upper tract urothelial carcinoma: a change of paradigm? A meta-analysis of aggregate data. Anticancer Drugs 2022; 33:e61-e68. [PMID: 34387596 DOI: 10.1097/cad.0000000000001200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We performed a systematic review and meta-analysis to evaluate the role of platinum-based adjuvant chemotherapy (AC) in upper tract urothelial carcinoma. Eligible studies were identified using Pubmed/Medline, Cochrane library, Embase and meeting abstracts. Outcomes of interest included: overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS). Platinum-based AC was associated with improved DFS, while the benefit in OS and CSS was not statistically significant compared to observation. Conversely, platinum-based AC showed a modest OS benefit in an analysis combing multivariable HRs with estimated HRs from Kaplan-Meier curves. Our results suggest that platinum-based AC is associated with improved DFS and a modest OS benefit in patients with locally advanced urothelial carcinomas.
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Affiliation(s)
| | - Alessandro Rizzo
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Veronica Mollica
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | | | | | | | - Andrea Ardizzoni
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
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11
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Barton GJ, Tan WP, Inman BA. The nephroureterectomy: a review of technique and current controversies. Transl Androl Urol 2020; 9:3168-3190. [PMID: 33457289 PMCID: PMC7807352 DOI: 10.21037/tau.2019.12.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The nephroureterectomy (NU) is the standard of care for invasive upper tract urothelial carcinoma (UTUC) and has been around for well over one hundred years. Since then new operative techniques have emerged, new technologies have developed, and the surgery continues to evolve and grow. In this article, we review the various surgical techniques, as well as present the literature surrounding current areas of debate surrounding the NU, including the lymphatic drainage of the upper urinary tract, management of UTUC involvement with the adrenals and caval thrombi, surgical management of the distal ureter, the use of intravesical chemotherapy as well as perioperative systemic chemotherapy, as well as various outcome measures. Although much has been studied about the NU, there still is a dearth of level 1 evidence and the field would benefit from further studies.
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Affiliation(s)
- Gregory J Barton
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Wei Phin Tan
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Brant A Inman
- Division of Urology, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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12
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Leow JJ, Chong YL, Chang SL, Valderrama BP, Powles T, Bellmunt J. Neoadjuvant and Adjuvant Chemotherapy for Upper Tract Urothelial Carcinoma: A 2020 Systematic Review and Meta-analysis, and Future Perspectives on Systemic Therapy. Eur Urol 2020; 79:635-654. [PMID: 32798146 DOI: 10.1016/j.eururo.2020.07.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/02/2020] [Indexed: 01/04/2023]
Abstract
CONTEXT To improve the prognosis of upper tract urothelial carcinoma (UTUC), clinicians have used neoadjuvant chemotherapy (NAC) or adjuvant chemotherapy (AC) before or after radical nephroureterectomy (RNU). Despite some new data, the evidence remains mixed on their efficacy. OBJECTIVE To update the current evidence on the role of NAC and AC for UTUC. EVIDENCE ACQUISITION We searched for all studies investigating NAC or AC for UTUC in Medline, Embase, the Cochrane Central Register of Controlled Trials, and abstracts from the American Society of Clinical Oncology meetings up to February 2020. A systematic review and meta-analysis was performed. EVIDENCE SYNTHESIS For NAC, the pooled pathologic complete response rate (≤ypT0N0M0) was 11% (n = 811) and pathologic partial response rate (≤ypT1N0M0) was 43% (n = 869), both across 14 studies. Across six studies, the pooled hazard ratios (HRs) were 0.44 (95% confidence interval [CI]: 0.32-0.59, p < 0.001) for overall survival (OS) and 0.38 (95% CI: 0.24-0.61, p < 0.001) for cancer-specific survival (CSS) in favor of NAC. The evidence for NAC is at best level 2. As for AC, there was a benefit in OS (pooled HR 0.77; 95% CI: 0.64-0.92, p = 0.004 across 14 studies and 7983 patients), CSS (pooled HR 0.79; 95% CI: 0.69-0.91, p = 0.001 across 18 studies and 5659 patients), and disease-free survival (DFS; pooled HR 0.52; 95% CI: 0.38-0.70 across four studies and 602 patients). While most studies were retrospective (level 2 evidence), there were two prospective randomized trials providing level 1 evidence. There are currently four phase 2 trials on neoadjuvant immunotherapy and three phase 2 trials on adjuvant immunotherapy for UTUC. CONCLUSIONS NAC for UTUC confers a favorable pathologic response and tumor downstaging rate, and an OS and CSS benefit compared with RNU alone. AC confers an OS, CSS, and DFS benefit compared with RNU alone. Currently, the evidence for AC appears stronger (with positive level 1 evidence) than that for NAC (at best level 2 evidence). Limited data are available for chemoimmunotherapy approaches, but preliminary data support an active research investment. PATIENT SUMMARY After a comprehensive search of the latest studies examining the role of neoadjuvant and adjuvant chemotherapy for upper tract urothelial cancer, the pooled evidence shows that perioperative chemotherapy was beneficial for prolonging survival; however, the evidence for adjuvant chemotherapy was stronger than that for neoadjuvant chemotherapy.
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Affiliation(s)
- Jeffrey J Leow
- Department of Urology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yew Lam Chong
- Department of Urology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Steven L Chang
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Begoña P Valderrama
- Department of Medical Oncology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Thomas Powles
- Barts Cancer Institute, Barts Health and the Royal Free NHS Trusts, London, UK
| | - Joaquim Bellmunt
- Beth Israel Deaconess Medical Center and PSMAR-IMIM Research Lab, Harvard Medical School, Boston, MA, USA.
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13
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Hwang EC, Sathianathen NJ, Jung JH, Kim MH, Narayan V, Hwang JE, Spiess PE, Dahm P. Perioperative systemic chemo-immunotherapy for upper urinary tract urothelial carcinoma. Hippokratia 2020. [DOI: 10.1002/14651858.cd013567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Eu Chang Hwang
- Chonnam National University Medical School, Chonnam National University Hwasun Hospital; Department of Urology; Hwasun Korea, South
| | | | - Jae Hung Jung
- Yonsei University Wonju College of Medicine; Department of Urology; 20 Ilsan-ro Wonju Gangwon Korea, South 26426
| | - Myung Ha Kim
- Yonsei University Wonju College of Medicine; Yonsei Wonju Medical Library; Wonju Korea, South
| | - Vikram Narayan
- University of Minnesota; Department of Urology; Minneapolis Minnesota USA
| | - Jun Eul Hwang
- Chonnam National University Medical School, Chonnam National University Hwasun Hospital; Department of Hematology-Oncology; Hwasun Korea, South
| | | | - Philipp Dahm
- Minneapolis VA Health Care System; Urology Section; One Veterans Drive Mail Code 112D Minneapolis Minnesota USA 55417
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14
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Quhal F, Mori K, Sari Motlagh R, Laukhtina E, Pradere B, Rouprêt M, Necchi A, Moschini M, Shariat SF. Efficacy of neoadjuvant and adjuvant chemotherapy for localized and locally advanced upper tract urothelial carcinoma: a systematic review and meta-analysis. Int J Clin Oncol 2020; 25:1037-1054. [PMID: 32206939 DOI: 10.1007/s10147-020-01650-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/02/2020] [Indexed: 11/26/2022]
Abstract
The objectives of this study are to evaluate the available literature regarding the oncologic effect of neoadjuvant and adjuvant chemotherapy in the treatment of patients with clinically non-metastatic upper tract urothelial carcinoma (UTUC) and locally advanced UTUC. We searched PubMed, Cochrane Library, and Scopus databases in November 2019, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We included studies that compared patients with non-metastatic UTUC who received either neoadjuvant or adjuvant chemotherapy with patients who underwent surgery alone. Subgroup meta-analyses were also performed for studies that investigated only locally advanced UTUC. Overall, 36 studies were included in the review of which 22 studies and 15,378 patients were eligible for the meta-analysis. Neoadjuvant chemotherapy (NAC) was associated with higher rates of pathological downstaging (pDS) (RR 6.48, 95% CI 2.05-20.44, p = 0.001) and pathological complete response (RR 18.46, 95% CI 3.34-99.24, p = 0.001); and this was also proven in a subgroup analysis of studies that evaluated pDS in locally advanced UTUC (RR 3.18, 95% CI 2.0-5.07, p < 0.001). The association of NAC with overall survival (OS) and cancer-specific survival (CSS) was also statistically significant in all patients and in patients with locally advanced UTUC. Adjuvant chemotherapy (AC) was associated with improved metastasis-free survival (HR 0.65, 95% CI 0.55-0.76, p < 0.001) and CSS (HR 0.66, 95% CI 0.57-0.77, p < 0.001), which continued to be true for the patients with locally advanced UTUC. The association of AC with OS was only significant in patients with locally advanced UTUC. Perioperative chemotherapy might provide better survival outcomes in patients with clinically non-metastatic UTUC treated with radical nephroureterectomy. Neoadjuvant chemotherapy seems to have promising results, although high level of evidence is still lacking. Despite the low level, the body of evidence suggests a need for multimodal therapy of invasive UTUC.
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Affiliation(s)
- Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, University Hospital of Tours, Tours, France
| | - Morgan Rouprêt
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Urology Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
- Department of Urology, Weill Cornell Medical College, New York, NY, USA.
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
- Department of Special Surgery, Jordan University Hospital, University of Jordan, Amman, Jordan.
- European Association of Urology Research Foundation, Arnhem, The Netherlands.
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15
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Kim DK, Kim JW, Jung HD, Ahn HK, Lee JY, Cho KS. Effects of Adjuvant Chemotherapy on Locally Advanced Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-analysis. Clin Genitourin Cancer 2019; 17:e1193-e1202. [DOI: 10.1016/j.clgc.2019.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 01/31/2023]
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16
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Kim M, Kim JK, Lee J, Kim YS, Lee JL, Kwak C, Jeong CW, Byun SS, Lee SC, Ohyama C, Arai Y, Ahn H. Adjuvant Treatments for Advanced Stage, Non-metastatic Upper Tract Urothelial Carcinoma: A Multicenter Study. Int J Radiat Oncol Biol Phys 2019; 104:819-827. [DOI: 10.1016/j.ijrobp.2019.03.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/13/2019] [Accepted: 03/16/2019] [Indexed: 12/11/2022]
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17
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Song W, Jeong JY, Jeon HG, Seo SI, Jeon SS, Choi HY, Lee HM, Sung HH. Impact of adjuvant chemotherapy on oncologic outcomes following radical nephroureterectomy for patients with pT3NanyM0 upper tract urothelial carcinoma: A retrospective cohort study. Int J Surg 2019; 66:12-17. [DOI: 10.1016/j.ijsu.2019.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 12/25/2022]
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18
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Nazzani S, Preisser F, Mazzone E, Tian Z, Mistretta FA, Shariat SF, Soulières D, Saad F, Montanari E, Luzzago S, Briganti A, Carmignani L, Karakiewicz PI. Survival effect of perioperative systemic chemotherapy on overall mortality in locally advanced and/or positive regional lymph node non-metastatic urothelial carcinoma of the upper urinary tract. World J Urol 2018; 37:1329-1337. [PMID: 30298285 DOI: 10.1007/s00345-018-2516-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/01/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To analyze the potential survival benefit of perioperative chemotherapy (CHT) in patients treated with nephroureterectomy (NU) for non-metastatic locally advanced upper tract urothelial carcinoma. METHODS Within the Surveillance, Epidemiology, and End Results database (2004-2014), we identified 1286 patients with T3 or T4, N 0-3 M0 UTUC. Kaplan-Meier plots, as well as multivariable Cox regression models (MCRMs) relying on inverse probability after treatment weighting (IPTW) and landmark analyses, were used to test the effect of CHT vs no CHT on overall mortality (OM) in the overall population (n =1286), as well as after stratification according to lymph node invasion (LNI). RESULTS Overall, 37.4% patients received CHT. The CHT rate was higher with LNI (62.2% vs 35.2%, p < 0.001). In MCRMs, testing for OM in the overall population, CHT was associated with lower rates of OM (HR 0.71, CI 0.58-0.87; p = 0.001). Similarly, in MCRMs testing for OM in patients with LNI, CHT achieved independent predictor status for lower OM (HR 0.61, CI 0.48-0.78; p < 0.001). Conversely, in MCRMs testing for OM in patients without LNI, no CHT effect was recorded (HR 0.72, CI 0.52-1.01; p = 0.05). All results were confirmed after IPTW adjustment and in landmark analyses. CONCLUSIONS Our results represent a contemporary North American report indicating lower OM after CHT for patients with locally advanced non-metastatic upper tract urothelial carcinoma, specifically in patients with T3-T4, N1-N3, M0 disease. Validation of the current and of the previous study is required within a randomized prospective design.
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Affiliation(s)
- Sebastiano Nazzani
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada. .,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, QC, Canada. .,Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Corso San Gottardo 12, Milano MI, Italy.
| | - Felix Preisser
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, QC, Canada.,Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Elio Mazzone
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, QC, Canada.,Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Zhe Tian
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, QC, Canada
| | | | | | - Denis Soulières
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, QC, Canada
| | - Fred Saad
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, QC, Canada
| | - Emanuele Montanari
- Department of Urology, IRCCS Fondazione Ca' Granda-Ospedale Maggiore Policlinico University of Milan, Milan, Italy
| | - Stefano Luzzago
- Department of Urology, IRCCS Fondazione Ca' Granda-Ospedale Maggiore Policlinico University of Milan, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Carmignani
- Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Corso San Gottardo 12, Milano MI, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, QC, Canada
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19
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Gregg RW, Vera-Badillo FE, Booth CM, Mahmud A, Brundage M, Leveridge MJ, Hanna TP. Perioperative chemotherapy for urothelial carcinoma of the upper urinary tract: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2018; 128:58-64. [PMID: 29958631 DOI: 10.1016/j.critrevonc.2018.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 01/19/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022] Open
Abstract
INTRODUCTION Upper tract urothelial carcinomas are rare malignancies with differences in anatomy and biology requiring therapeutic strategies that differ from bladder cancer. The role of perioperative systemic therapy in this disease remains uncertain with limited data to support its use. A systematic review of the literature and meta-analysis was therefore undertaken to provide more information and guide clinical practice. METHODS A literature search was performed using Embase and Medline databases with additional searches performed manually using terms associated with upper tract urothelial malignancies. Data was extracted from studies of patients that underwent nephrouretectomy for the management of upper tract urothelial carcinoma and received either neoadjuvant or adjuvant systemic therapy. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were summated and analyzed using Cochrane Revman software Version 5.3. RESULTS There were 13 comparative studies and no randomized studies identified for data extraction; 11 adjuvant and 2 neoadjuvant with 1170 patients receiving perioperative systemic therapy and 3472 controls that did not. Perioperative chemotherapy was associated with improved OS (HR 0.75, 95%CI 0.57-0.99), DFS (HR 0.54, 95%CI 0.32-0.92), and CSS (HR 0.69, 95%CI 0.42-1.15). CONCLUSIONS The available data suggests that perioperative systemic therapy is associated with improved survival in patients with upper tract urothelial cancer.
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Affiliation(s)
- Richard W Gregg
- Department of Oncology, Queen's University, Canada; Cancer Centre of Southeastern Ontario, Canada.
| | - Francisco E Vera-Badillo
- Department of Oncology, Queen's University, Canada; Cancer Centre of Southeastern Ontario, Canada; Canadian Cancer Trials Group, Queen's Cancer Research Institute, Canada
| | - Christopher M Booth
- Department of Oncology, Queen's University, Canada; Cancer Centre of Southeastern Ontario, Canada; Cancer Care and Epidemiology, Queen's Cancer Research Institute, Canada
| | - Aamer Mahmud
- Department of Oncology, Queen's University, Canada; Cancer Centre of Southeastern Ontario, Canada
| | - Michael Brundage
- Department of Oncology, Queen's University, Canada; Cancer Centre of Southeastern Ontario, Canada; Cancer Care and Epidemiology, Queen's Cancer Research Institute, Canada
| | - Michael J Leveridge
- Department of Oncology, Queen's University, Canada; Department of Urology, Queen's University, Canada
| | - Timothy P Hanna
- Department of Oncology, Queen's University, Canada; Cancer Centre of Southeastern Ontario, Canada; Cancer Care and Epidemiology, Queen's Cancer Research Institute, Canada
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20
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Goldberg H, Klaassen Z, Chandrasekar T, Sayyid R, Kulkarni GS, Hamilton RJ, Fleshner NE. Does perioperative chemotherapy improve survival in upper tract urothelial carcinoma? A population based analysis. Oncotarget 2018; 9:18797-18810. [PMID: 29721162 PMCID: PMC5922356 DOI: 10.18632/oncotarget.24694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/24/2018] [Indexed: 01/01/2023] Open
Abstract
Objectives To evaluate the utilization and outcomes of perioperative chemotherapy in non-metastatic UTUC patients over the past decade using a large national database. Methods All patients aged 18 and older diagnosed with non-metastatic UTUC between 2004 and 2013 were identified within the Surveillance, Epidemiology and End Results (SEER) database. Relevant clinical data was collected and predictors of cancer specific mortality (CSM) and other cause mortality (OCM) were analyzed. Results The total cohort included 8,762 patients. Of these, 1,402 (16%) patients received chemotherapy, including only 35% of high-risk patients (>pT2 or N1). Treated patients had higher CSM (21.3% vs. 13.1%, p<0.001). Predictors of chemotherapy utilization included residence in Midwest states, tumor located in the ureter, higher stage and grade. Predictors of CSM included older age, residence in southern states, receipt of chemotherapy (HR = 1.151, 95% CI: 1.003-1.32, p=0.044), higher stage and grade. OCM was predicted by male gender, older age, ureteral tumor, and higher stage. A subset analysis of patients younger than 65 showed similar predictors, while an analysis of high risk patients demonstrated that chemotherapy receipt did not predict CSM or OCM. Conclusions In this large contemporary non-metastatic UTUC cohort, chemotherapy utilization was found to be quite infrequent, but increasing steadily. Perioperative chemotherapy had no effect on CSM in high-risk patients, while correlated to higher CSM in the younger patients.
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Affiliation(s)
- Hanan Goldberg
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Zachary Klaassen
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Thenappan Chandrasekar
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Rashid Sayyid
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Neil E Fleshner
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
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Yang X, Li P, Deng X, Dong H, Cheng Y, Zhang X, Yang C, Tang J, Yuan W, Xu X, Tao J, Li P, Yang H, Lu Q, Gu M, Wang Z. Perioperative treatments for resected upper tract urothelial carcinoma: a network meta-analysis. Oncotarget 2018; 8:3568-3580. [PMID: 27683040 PMCID: PMC5356904 DOI: 10.18632/oncotarget.12239] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 09/20/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Perioperative treatments have been used to improve prognosis in patients with upper tract urothelial carcinoma (UTUC). However, optimal management remains unestablished. METHODS We searched the Embase, Web of Science and Cochrane databases for studies published before June 20, 2015. All included studies were categorised into three groups on the basis of the outcome reported (overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS)). Relative hazard ratios (HRs) for death were calculated using random-effects Bayesian network meta-analysis methods. We also ranked the three different treatments in terms of three outcomes. RESULTS A total of 31 trials with 8100 patients were included. Compared with the control, adjuvant chemotherapy (AC) could improve OS, DSS and RFS by 32% (HR 0.68, 95% CI 0.51-0.89), 29% (HR 0.71, 95% CI 0.54-0.89) and 51% (HR 0.49, 95% CI 0.23-0.85), respectively. We noted a marked prolongation of RFS in both intravesical chemotherapy (HR 0.32, 95% CI 0.09-0.69) as well as concurrent radiotherapy and intravesical chemotherapy (HR 0.32, 95% CI 0.03-0.97) than in the control. Neoadjuvant chemotherapy (NAC) showed a significant improvement in DSS relative to the control (HR 0.25, 95% CI 0.06-0.61) and a distinct advantage over AC (HR 0.36, 95% CI 0.08-0.90) or AR (HR 6.89, 95% CI 1.25-18.66). CONCLUSIONS Our results showed that AC; intravesical chemotherapy; and concurrent radiotherapy and intravesical chemotherapy could improve the prognosis of UTUC patients. NAC was found to be more favourable for UTUC than AC in terms of DSS.
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Affiliation(s)
- Xiao Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Peng Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaheng Deng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongquan Dong
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yidong Cheng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaolei Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chengdi Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jingyuan Tang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenbo Yuan
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoting Xu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Tao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengchao Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Haiwei Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Lu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Gu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zengjun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Kim HS, Jeong CW, Kwak C, Kim HH, Ku JH. Association between demographic factors and prognosis in urothelial carcinoma of the upper urinary tract: a systematic review and meta-analysis. Oncotarget 2018; 8:7464-7476. [PMID: 27448978 PMCID: PMC5352335 DOI: 10.18632/oncotarget.10708] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/06/2016] [Indexed: 01/23/2023] Open
Abstract
We aimed to assess the prognostic significance of demographic factors, including age, sex, performance status, smoking status, obesity, and race in upper urinary tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy through a systematic review and meta-analysis. We conducted PubMed search for all articles published until December 2014 according to Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Survival outcomes of interest were intravesical recurrence (IVR) free survival, progression free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Seventy-nine studies, including numbers of subjects ranging from 24 to 9899, met the inclusion criteria. Advanced age was significantly associated with worse PFS [hazard ratio (HR) 1.01] and OS (HR 1.05). The significant predictors of CSS were age (HR 1.02) and performance status (HR 1.35). Female gender (HR 0.81) and smoking (HR 1.38) were the significant predictors only for IVR free survival. No significant associations with survival outcomes were observed in obesity and race. Our study reveals that age is one of the most important demographic predictor of survival in UTUC. Also, male gender, poor performance status, and smoking are also significantly related to worse survival outcomes. However, large well-designed prospective studies are required to investigate the precise prognostic significance of demographics.
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Affiliation(s)
- Hyung Suk Kim
- Department of Urology, Dongguk University Ilsan Medical Center, Goyang, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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Joshi SS, Quast LL, Chang SS, Patel SG. Effects of tumor size and location on survival in upper tract urothelial carcinoma after nephroureterectomy. Indian J Urol 2018; 34:68-73. [PMID: 29343916 PMCID: PMC5769253 DOI: 10.4103/iju.iju_216_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Introduction: Upper Tract Urothelial Carcinoma (UTUC) is a rare disease with few prognostic determinants. We sought to evaluate the impact of tumor size and location on patient survival following nephroureterectomy for UTUC. Materials and Methods: Data on 8284 patients treated with radical nephroureterectomy for UTUC in the United States between 1998 and 2011 were analyzed from the National Cancer Data Base. Univariable survivorship curves were generated based on pT stage, pN stage, grade, tumor size, and tumor site (renal pelvis vs. ureter). A Cox proportional hazards model was used to evaluate the effect of age, comorbidity, T stage, lymph node involvement, tumor site, and tumor size on survival. Results: The median follow-up time was 46 months. A majority of the patients were male (55.4%) with a tumor size of ≥3.5 cm (52.0%) and pT stage <T2 (47.8%). The overall 5 years survival overall survival (OS) for the entire cohort was 51.6%. When stratified by tumor size <3.5 cm or ≥3.5 cm the 5-year OS was 45.9% and 58.5%, respectively. On multivariable analysis controlling for age, Charlson comorbidity index, grade, and tumor stage, tumor size ≥3.5 cm was independently predictive of worse OS (odds ratio: 1.13 [95% confidence interval: 1.02–1.26], P = 0.023). Conclusions: Using the largest series of patients with UTUC undergoing nephroureterectomy, we demonstrated a worse survival in patients with larger tumor sizes (≥3.5 cm) but no difference in survival based on tumor location while controlling for other pathologic characteristics. Incorporation of tumor size into perioperative risk modeling may help with patient stratification and provide further prognostic information for patient counseling.
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Affiliation(s)
- Shreyas S Joshi
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura L Quast
- Department of Urologic Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Sam S Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sanjay G Patel
- Department of Urology, University of Oklahoma Health Sciences Center, Norman, OK, USA
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Efficacy of post-nephroureterectomy cisplatin-based adjuvant chemotherapy for locally advanced upper tract urothelial carcinoma: a multi-institutional retrospective study. World J Urol 2017; 35:1569-1575. [PMID: 28397000 DOI: 10.1007/s00345-017-2032-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate the efficacy of adjuvant systemic chemotherapy for locally advanced (pT3-4pN0/xM0) upper tract urothelial carcinoma (UTUC). MATERIALS AND METHODS We retrospectively reviewed the medical records of 109 patients with pT3-4pN0/xM0 UTUC who had undergone radical nephroureterectomy between 1996 and 2013 at our four institutions. The patients were divided into two groups: those who received adjuvant chemotherapy (AC group) and those who did not (surgery-alone: SA group). All chemotherapy regimens were cisplatin-based. Cox proportional hazards regression models addressed the associations between clinicopathological factors and recurrence-free survival (RFS) and cancer-specific survival (CSS). RESULTS Forty-three (39.5%) out of the 109 patients underwent one to four cycles of adjuvant chemotherapy after nephroureterectomy. Median follow-up was 46.5 months. There were no significant differences in the background characteristics of the two groups, except for age. Recurrence developed in 11 (25.6%) and 29 (43.9%) patients in the AC and SA groups, respectively. Ultimately, six (14.0%) and 18 (27.3%) patients in the AC and SA groups, respectively, died of disease progression. On univariate analysis, hydronephrosis, nuclear grade, lymphovascular invasion, and adjuvant chemotherapy were significantly associated with both RFS and CSS. Charlson comorbidity index was associated only with CSS. On multivariate analysis, adjuvant chemotherapy was the only independent factor associated with improved RFS (p = 0.0178, HR = 0.41). Moreover, adjuvant chemotherapy (p = 0.0375, HR = 0.33), lower nuclear grade (p = 0.0070), and the absence of hydronephrosis (p = 0.0493) were independently associated with better CSS. CONCLUSION Locally advanced (pT3-4pN0/xM0) UTUC patients who underwent cisplatin-based adjuvant chemotherapy demonstrated better RFS and CSS than those without adjuvant chemotherapy.
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Perioperative chemotherapy in upper tract urothelial carcinoma: a comprehensive review. World J Urol 2017; 35:1401-1407. [PMID: 28074261 DOI: 10.1007/s00345-016-1995-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/19/2016] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To evaluate the role of neoadjuvant (NAC) and adjuvant chemotherapy (AC) in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). METHODS A comprehensive review of the current literature was performed searching for all studies investigating NAC and AC in UTUC in MEDLINE and https://clinicaltrials.gov , prior to April 2016. The following keywords were used: "ureteral neoplasms," "urothelium," "ureter," "upper tract urothelial," "chemotherapy," "adjuvant," "neoadjuvant" and relevant variants. RESULTS No randomized trials investigated the role of AC or NAC for UTUC. There was one prospective study with n = 36 patients investigating AC with carboplatin-paclitaxel. We included 14 retrospective studies (four in the NAC and ten in the AC setting), with a total of 694 patients receiving cisplatin-based or non-cisplatin-based AC after RNU and 1437 patients undergoing RNU alone. We found that the current literature, mainly based on retrospective studies, suggests significant overall and cancer-specific survival benefits for AC in UTUC. NAC appears promising, with favorable pathologic response rates up to 14%. CONCLUSIONS Evidence is scarce for both NAC and AC use in UTUC. This comprehensive review suggests promising response rates for NAC and a survival benefit for patients treated with AC. Prospective randomized trials are needed to establish the role of AC and NAC in UTUC.
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Song W, Sung HH, Han DH, Jeong BC, Seo SI, Jeon SS, Lee HM, Choi HY, Jeon HG. The effect of contralateral kidney volume on renal function after radical nephroureterectomy: Implications for eligibility for neoadjuvant chemotherapy for upper tract urothelial cancer. Urol Oncol 2016; 35:114.e1-114.e7. [PMID: 27908680 DOI: 10.1016/j.urolonc.2016.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 09/10/2016] [Accepted: 10/31/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE We investigated the effect of preoperative contralateral kidney (CK) volume on renal function after radical nephroureterectomy (RNU). METHODS We reviewed 630 patients who underwent RNU between September 1994 and December 2013. Of these 630 patients, 135 patients with advanced upper tract urothelial cancer were ultimately included. Preoperative CK volume was measured from computed tomography images of the venous phase using a specialized volumetric program. Glomerular filtration rate (GFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations and checked preoperatively, 7 days, 1, 3, and 12 months postoperatively. RESULTS The mean age at surgery was 62.1 (10.1) years and the mean CKD-EPI GFR was 73.8 (75.5) ml/min/1.73m2. After RNU, new-onset CKD was identified in 69 (51.1%) patients. On multivariate logistic regression analysis, high body mass index (95% CI: 1.08-1.51, P = 0.005), low preoperative CKD-EPI GFR (95% CI: 0.92-0.98, P = 0.037), and low CK volume (95% CI: 0.96-0.99, P<0.001) were associated with new-onset CKD at 1 month after RNU. There was a positive correlation between CK volume and CKD-EPI GFR at 1 month after RNU (Spearman ρ = 0.495, P<0.001). When stratified according to CK volume, CK volume less than 150ml was significantly associated with new-onset CKD after RNU (95% CI: 2.49-26.29, P = 0.001). CONCLUSIONS High body mass index, low preoperative CKD-EPI GFR, and low CK volume are significantly associated with new-onset CKD. Therefore, they could be used to identify patients eligible for neoadjuvant chemotherapy in upper tract urothelial cancer.
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Affiliation(s)
- Wan Song
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Deok Hyun Han
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Han Yong Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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External validation of the pathological nodal staging score in upper tract urothelial carcinoma: A population-based study. Urol Oncol 2016; 35:33.e21-33.e26. [PMID: 27816402 DOI: 10.1016/j.urolonc.2016.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/09/2016] [Accepted: 07/29/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To externally validate our previously developed pathological nodal staging model (pNSS) that allows quantification of the likelihood that a patient with pathologic node-negative status has, indeed, no lymph node metastasis (LNM). PATIENTS AND METHODS We analyzed data from 2,768 patients treated with radical nephroureterectomy (RNU) and lymph node dissection (LND) using the Surveillance, Epidemiology, and End Results database from 1988 to 2010. We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a new pNSS. Then, we compared these findings with those of the initial cohort. RESULTS The mean and median numbers of lymph node (LN) removed were 5 and 2, respectively (interquartile range = 5) in the validation cohort, though 66.5% of the patients (n = 1814) were pN0. Similar to the development cohort, the probability of missing a LNM decreased as the number of nodes examined increased in the validation cohort. If only a single node was examined, 35% of patients would be misclassified as pN0 while harboring LNM. Even when 5 nodes were examined, 8% would be misclassified. The probability of having a positive node increased with advancing pathological T stage in both the cohorts. Patients with pT0-Ta-Tis-T1 disease in both cohorts would have more than a 95% chance of a correct pathologic nodal staging with 2 examined nodes. However, if a patient has pT3-T4 disease, more than 12 examined LNs are needed to reach 95% accuracy. CONCLUSIONS We confirmed that the number of examined nodes needed for adequate staging depends on pT category. We externally validated our previous pNSS in a population-based database, which could help in the clinical decision-making regarding adjuvant chemotherapy administration.
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Cao J, Zhao X, Zhong Z, Zhang L, Zhu X, Xu R. Prognostic Value of Pre-operative Renal Insufficiency in Urothelial Carcinoma: A Systematic Review and Meta-Analysis. Sci Rep 2016; 6:35214. [PMID: 27725745 PMCID: PMC5057078 DOI: 10.1038/srep35214] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/27/2016] [Indexed: 02/05/2023] Open
Abstract
The effect of pre-operative renal insufficiency on urothelial carcinoma (UC) prognosis has been investigated by numerous studies. While the majority report worse UC outcomes in patients with renal insufficiency, the results between the studies differed wildly. To enable us to better estimate the prognostic value of renal insufficiency on UC, we performed a systematic review and meta-analysis based on the published literature. A total of 16 studies which involved 5,232 patients with UC, investigated the relationship between pre-operative renal insufficiency and disease prognosis. Estimates of combined hazard ratio (HR) for bladder urothelial carcinoma recurrence, cancer-specific survival (CSS) and overall survival (OS) were 1.65 (95% CI, 1.11–2.19), 1.59 (95% CI, 1.14–2.05) and 1.45 (95% CI, 1.19–1.71), respectively; and for upper urinary tract urothelial carcinoma recurrence, CSS and OS were 2.27 (95% CI, 1.42–3.12), 1.02 (95% CI, 0.47–1.57) and 1.52 (95% CI, 1.05–1.99), respectively. Our results indicate that UC patients with pre-operative renal insufficiency tend to have higher recurrence rates and poorer survival compared to those with clinically normal renal function, thus renal function should be closely monitored in these patients. The impact of intervention for renal insufficiency on the prognosis of UC needs to be further studied.
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Affiliation(s)
- Jian Cao
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China.,MRC Centre for Reproductive Health, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - Xiaokun Zhao
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China
| | - Zhaohui Zhong
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China
| | - Lei Zhang
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China
| | - Xuan Zhu
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China
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Are the Formulas Used to Estimate Renal Function Adequate for Patients Treated With Cisplatin-Based Chemotherapy After Nephroureterectomy for Upper Tract Urothelial Carcinoma? Clin Genitourin Cancer 2016; 14:e501-e507. [DOI: 10.1016/j.clgc.2016.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 04/18/2016] [Accepted: 04/22/2016] [Indexed: 01/26/2023]
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Interplay between chronic kidney disease (CKD) and upper tract urothelial carcinomas (UUC): foe or friend? Oncotarget 2016; 7:53951-53958. [PMID: 27256983 PMCID: PMC5288235 DOI: 10.18632/oncotarget.9753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/23/2016] [Indexed: 02/07/2023] Open
Abstract
Although upper tract urothelial carcinomas (UUC) is curable through nephrectomy or nephroureterectomy, progression of chronic kidney disease (CKD) and CKD-related mortality have been highlighted as clinical challenges in recent years owing to the loss of a large number of nephrons. While CKD can promote the development of UUC, other risk factors such as hypertension, diabetes mellitus, advanced age, and anemia can facilitate the progression of CKD. Conversely, CKD is especially prevalent in UUC patients. However, the relationship between CKD and UUC, mechanisms for CKD causing UUC, and gender disparity of UUC of CKD patients have so far not been well-reviewed. As UUC gradually grows, the cancer can be a physical obstacle in the urinary tract. It will cause an increased tract pressure, subsequently resulting in the dysfunction of both nephrons and kidney. At the molecular level, reduced level of oxidative stress was observed in female UUC patients. Furthermore, radical nephrectomy therapy for UUC patients accelerates the progress of chronic kidney dysfunction. Incidentally, the remedies for CKD containing aristolochic acid (AA) are carcinogenic. Our present review offers a comprehensive look at the relationship between CKD and UUC from multiple perspectives. Early and precise identification of progression of CKD and UUC will benefit the patients at high-risk of CKD or UUC, which will also be instructive in directing timely and effective therapeutic interventions whenever necessary. It may also shed light on unveiling the underlying mechanisms of carcinogenesis of UUC, preventing CKD progression, and prolonging the patients' overall survival.
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Kim HS, Lee JS, Jeong CW, Kwak C, Kim HH, Ku JH. Adjuvant chemotherapy for locally advanced upper tract urothelial carcinoma: updated results of the Seoul National University Hospital experience. Int Braz J Urol 2016; 41:1067-79. [PMID: 26742963 PMCID: PMC4756931 DOI: 10.1590/s1677-5538.ibju.2015.0009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 05/04/2015] [Indexed: 11/22/2022] Open
Abstract
Objectives: The objective of this study was to update the long-term outcome in the treatment of locally advanced upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU) regarding the role of adjuvant chemotherapy. Materials and methods: Clinical data from 138 patients who underwent RNU for locally advanced UTUC (pT3/4 or pN+) were analyzed. Results: The adjuvant chemotherapy group comprised 66 patients, and other 72 patients did not receive adjuvant chemotherapy. Cisplatin-based chemotherapy was the most common regimen, depending on the patient's eligibility and renal function. The median follow-up period was 48.7 months (interquartile range: 29.2-96.9 months). The 3-and 5-year disease-specific survival (DSS) rates were 76.0% and 69.9% for the non-adjuvant chemotherapy group versus 74.6% and 54.5% for the adjuvant chemotherapy group (p=0.301, log-rank test). Overall survival (OS) rates for the same time period were 70.1% and 62.9% for the non-adjuvant chemotherapy group versus 73.8% and 53.2% for the adjuvant chemotherapy group (p=0.931, log-rank test). On multivariate analysis, adjuvant chemotherapy could not predict DSS and OS after surgery. When patients who received cisplatin-based adjuvant chemotherapy (n=59) were compared to those who did not receive adjuvant chemotherapy, similar results were found. Conclusions: There does not appear to be a significant DSS or OS benefit associated with adjuvant chemotherapy. Prospective randomized clinical trials are necessary to verify the effect of adjuvant chemotherapy on locally advanced UTUC.
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Affiliation(s)
- Hyung Suk Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Joong Sub Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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Shibing Y, Liangren L, Qiang W, Hong L, Turun S, Junhao L, Lu Y, Zhengyong Y, Yonghao J, Guangqing F, Yunxiang L, Dehong C. Impact of tumour size on prognosis of upper urinary tract urothelial carcinoma after radical nephroureterectomy: a multi-institutional analysis of 795 cases. BJU Int 2016; 118:902-910. [PMID: 26935344 DOI: 10.1111/bju.13463] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yan Shibing
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu Sichuan Province China
- Department of Urology; Dujiangyan Medical Center/Affiliated Hospital of Chengdu University; Dujiangyan City Sichuan Province China
| | - Liu Liangren
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Wei Qiang
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Liao Hong
- Department of Urology; Sichuan Provincial Cancer Hospital/the Second Provincial Hospital of Sichuan Province; Chengdu Sichuan Province China
| | - Song Turun
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Lei Junhao
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Yang Lu
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Yuan Zhengyong
- Department of Urology; Dujiangyan Medical Center/Affiliated Hospital of Chengdu University; Dujiangyan City Sichuan Province China
- Department of Urology; First Affiliated Hospital of Chongqing Medical University; Chongqing Sichuan Province China
| | - Jiang Yonghao
- Department of Urology; Second People's Hospital of Yibin City; Yibin City Sichuan Province China
| | - Fu Guangqing
- Department of Urology; Fourth People's Hospital of Zigong City; Zigong City Sichuan Province China
| | - Li Yunxiang
- Department of Urology; Nanchong Central Hospital; Nanchong City Sichuan Province China
| | - Cao Dehong
- Department of Urology; Institute of Urology; West China Hospital; Sichuan University; Chengdu Sichuan Province China
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Kikuchi E, Miyazaki J, Yuge K, Hagiwara M, Ichioka D, Inoue T, Kageyama S, Sugimoto M, Mitsuzuka K, Matsui Y, Yamamoto S, Kinoshita H, Wakeda H, Hanai K, Nishiyama H. Do metastatic upper tract urothelial carcinoma and bladder carcinoma have similar clinical responses to systemic chemotherapy? A Japanese multi-institutional experience. Jpn J Clin Oncol 2015; 46:163-9. [PMID: 26657277 DOI: 10.1093/jjco/hyv180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/02/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE There has been no clear evidence supporting similar chemo-responses for upper and lower urothelial carcinomas. METHODS We conducted a multicenter retrospective cohort study to analyze urothelial carcinoma patients who underwent systemic chemotherapy at 17 centers from 2004 to 2010. A total of 298 patients with either urothelial carcinoma of the bladder (N = 151) or upper tract urothelial carcinoma (N = 147) were included. Differences in tumor location (urothelial carcinoma of the bladder vs. upper tract urothelial carcinoma) were evaluated in relation to the patient backgrounds and clinical responses to systemic chemotherapy. RESULTS Overall 216 patients were treated with cisplatin-based chemo-regimens (gemcitabine and cisplatin in 92, or methotrexate, vinblastine, adriamycin and cisplatin/methotrexate, epirubicin and cisplatin in 124). Among 186 initially metastatic patients, the incidences of lung metastasis and liver metastasis were 39.2 and 34.1%, respectively, in upper tract urothelial carcinoma patients, and were significantly higher than those with urothelial carcinoma of the bladder (22.4% for lung; 8.4% for liver metastasis). Among 112 post-surgical recurrent/metastatic patients, age was significantly higher and estimated glomerular filtration rate at baseline was significantly lower in upper tract urothelial carcinoma patients than those with urothelial carcinoma of the bladder. No significant differences were observed in overall clinical response rates for systemic chemotherapy between urothelial carcinoma of the bladder (45.8%) and upper tract urothelial carcinoma (38%) in initially metastatic patients or between urothelial carcinoma of the bladder (43.2%) and upper tract urothelial carcinoma (44.1%) in post-surgical recurrent/metastatic patients. Tumor location was not independently associated with cancer-specific survival in either initially metastatic or post-surgical recurrent/metastatic urothelial carcinoma patients. CONCLUSIONS No significant difference was observed in response rates of urothelial carcinoma of the bladder and upper tract urothelial carcinoma to systemic chemotherapy, suggesting that a similar chemo-regimen can be applied to metastatic urothelial carcinoma patients regardless of tumor location (upper vs. lower).
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Affiliation(s)
- Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo
| | - Jun Miyazaki
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba
| | - Kazuyuki Yuge
- Department of Urology, Keio University School of Medicine, Tokyo
| | | | - Daishi Ichioka
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba
| | - Takamitsu Inoue
- Department of Urology, Akita University School of Medicine, Akita
| | - Susumu Kageyama
- Department of Urology, Shiga University of Medical Science, Otsu
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Takamatsu
| | - Koji Mitsuzuka
- Department of Urology, Graduate School of Medicine, Tohoku University, Sendai
| | - Yoshiyuki Matsui
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto
| | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Nishinomiya
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Hirakata
| | - Hironobu Wakeda
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki
| | - Kazuya Hanai
- Department of Urology, Tokai University Hospital, Isehara
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba Tsukuba Critical Path Research and Education Integrated Leading Center, Tsukuba, Japan
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Kondo T, Takagi T, Tanabe K. Therapeutic role of template-based lymphadenectomy in urothelial carcinoma of the upper urinary tract. World J Clin Oncol 2015; 6:237-51. [PMID: 26677437 PMCID: PMC4675909 DOI: 10.5306/wjco.v6.i6.237] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/14/2015] [Accepted: 10/01/2015] [Indexed: 02/06/2023] Open
Abstract
Lymphadenectomy for urothelial carcinoma of the upper urinary tract has attracted the attention of physicians. The mapping study of lymphatic spread has shown that a relatively wide area should comprise the regional nodes for tumors of the right renal pelvis or the right upper two-thirds of the ureter. A prospective study showed that an anatomical template-based lymphadenectomy significantly improved patient survival in tumors of the renal pelvis. This benefit was more evident for patients with pT2 stage tumors or higher. The risk of regional node recurrence is significant reduced by template-based lymphadenectomy, which is likely to be associated with improved patient survival. The removal of lymph node micrometastases is assumed to be the reason for therapeutic benefit following lymphadenectomy. The number of resected lymph nodes can be used to assess the quality of lymphadenectomy, but not to determine the extent of lymphadenectomy. The guidelines currently recommend lymphadenectomy for patients with muscle-invasive disease, even though the current recommendation grades are still low. The present limitation of lymphadenectomy is the lack of standardization of the extent of lymphadenectomy and the randomized trials. Further studies are warranted to collect the evidence to support lymphadenectomy.
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The comparison of oncologic outcomes between metastatic upper tract urothelial carcinoma and urothelial carcinoma of the bladder after cisplatin-based chemotherapy. Urol Oncol 2015; 33:495.e9-495.e14. [DOI: 10.1016/j.urolonc.2015.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/28/2015] [Accepted: 07/05/2015] [Indexed: 12/22/2022]
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Fujita K, Inamoto T, Yamamoto Y, Tanigawa G, Nakayama M, Mori N, Tsujihata M, Azuma H, Nonomura N, Uemura M. Role of adjuvant chemotherapy for lymph node-positive upper tract urothelial carcinoma and the prognostic significance of C-reactive protein: A multi-institutional, retrospective study. Int J Urol 2015; 22:1006-12. [DOI: 10.1111/iju.12868] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/10/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Kazutoshi Fujita
- Department of Urology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| | - Teruo Inamoto
- Department of Urology; Osaka Medical College; Takatsuki Osaka Japan
| | | | - Go Tanigawa
- Department of Urology; Osaka General Medical Center; Osaka Japan
| | - Masashi Nakayama
- Department of Urology; Osaka Medical Center for Cancer and Cardiovascular Diseases; Osaka Japan
| | - Naoki Mori
- Department of Urology; Sumitomo Hospital; Osaka Japan
| | - Masao Tsujihata
- Department of Urology; Osaka Rosai Hospital; Sakai Osaka Japan
| | - Haruhito Azuma
- Department of Urology; Osaka Medical College; Takatsuki Osaka Japan
| | - Norio Nonomura
- Department of Urology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| | - Motohide Uemura
- Department of Urology; Osaka University Graduate School of Medicine; Suita Osaka Japan
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Shirotake S, Kikuchi E, Tanaka N, Matsumoto K, Miyazaki Y, Kobayashi H, Ide H, Obata J, Hoshino K, Kaneko G, Hagiwara M, Kosaka T, Kanao K, Kodaira K, Hara S, Oyama M, Momma T, Miyajima A, Nakagawa K, Hasegawa S, Nakajima Y, Oya M. Impact of an Adjuvant Chemotherapeutic Regimen on the Clinical Outcome in High Risk Patients with Upper Tract Urothelial Carcinoma: A Japanese Multi-Institution Experience. J Urol 2015; 193:1122-8. [DOI: 10.1016/j.juro.2014.10.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Suguru Shirotake
- 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
| | - Eiji Kikuchi
- 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
| | - Nobuyuki Tanaka
- 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
| | - Kazuhiro Matsumoto
- 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
| | - Yasumasa Miyazaki
- 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
| | - Hiroaki Kobayashi
- 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
| | - Hiroki Ide
- 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
| | - Jun Obata
- 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
| | - Katsura Hoshino
- 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
| | - Gou Kaneko
- 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
| | - Masayuki Hagiwara
- 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
| | - Takeo Kosaka
- 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
| | - Kent Kanao
- 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
| | - Kiichiro Kodaira
- 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
| | - Satoshi Hara
- 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
| | - Masafumi Oyama
- 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
| | - Tetsuo Momma
- 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
| | - Akira Miyajima
- 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
| | - Ken Nakagawa
- 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
| | - Shintaro Hasegawa
- 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
| | - Yosuke Nakajima
- 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
| | - Mototsugu Oya
- 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
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Lucca I, Leow JJ, Shariat SF, Chang SL. Diagnosis and Management of Upper Tract Urothelial Carcinoma. Hematol Oncol Clin North Am 2015; 29:271-88, ix. [DOI: 10.1016/j.hoc.2014.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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A contemporary review of management and prognostic factors of upper tract urothelial carcinoma. Cancer Treat Rev 2015; 41:310-9. [DOI: 10.1016/j.ctrv.2015.02.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 02/09/2015] [Accepted: 02/11/2015] [Indexed: 01/02/2023]
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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. The role of adjuvant chemotherapy for lymph node-positive upper tract urothelial carcinoma following radical nephroureterectomy: a retrospective study. BJU Int 2015; 116:72-8. [PMID: 24825476 DOI: 10.1111/bju.12801] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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(all) 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.
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Affiliation(s)
- Ilaria Lucca
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Wassim Kassouf
- Department of Urology, McGill University, Montreal, QC, Canada
| | - Anil Kapoor
- Department of Urology, McMaster University, Hamilton, ON, Canada
| | - Adrian Fairey
- Department of Surgery (Urology), University of Alberta, Edmonton, AB, Canada
| | | | - Jonathan I Izawa
- Department of Surgery (Urology), University of Western Ontario, London, ON, Canada
| | - Peter C Black
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Harun Fajkovic
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Mesut Remzi
- Department of Urology, Landeskrankenhaus Weinviertel-Korneuburg, Korneuburg, Austria
| | - Peter Nyirády
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Morgan Rouprêt
- Department of Urology, Groupe Hospitalier Pitié - Salpêtrière, Assistance Publique Hopitaux de Paris, Faculty of Medicine Pierre et Marie Curie, Institut Universitaire de Cancérologie GRC5, University Paris 6, Paris, France
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michela de Martino
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Sebastian L Hofbauer
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Novara
- Department of Surgical, Oncological and Gastroenterologic Sciences, Urology Clinic, University of Padua, Padua, Italy
| | - Shahrokh F Shariat
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Tobias Klatte
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
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Audenet F, Rouprêt M, Houédé N, Colin P. Traitements non chirurgicaux des tumeurs de la voie excrétrice supérieure : état-de-l’art pour le rapport annuel de l’Association française d’urologie. Prog Urol 2014; 24:1030-40. [DOI: 10.1016/j.purol.2014.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 06/27/2014] [Accepted: 07/06/2014] [Indexed: 11/26/2022]
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Leow JJ, Martin-Doyle W, Fay AP, Choueiri TK, Chang SL, Bellmunt J. A Systematic Review and Meta-analysis of Adjuvant and Neoadjuvant Chemotherapy for Upper Tract Urothelial Carcinoma. Eur Urol 2014; 66:529-41. [DOI: 10.1016/j.eururo.2014.03.003] [Citation(s) in RCA: 194] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 03/04/2014] [Indexed: 02/03/2023]
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Nomogram predicting renal insufficiency after nephroureterectomy for upper tract urothelial carcinoma in the Chinese population: exclusion of ineligible candidates for adjuvant chemotherapy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:529186. [PMID: 25180185 PMCID: PMC4142385 DOI: 10.1155/2014/529186] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/26/2014] [Accepted: 07/16/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To report the decline of renal function after radical nephroureterectomy (RNU) in upper tract urothelial carcinoma (UTUC) patients and to develop a nomogram to predict ineligibility for cisplatin-based adjuvant chemotherapy (AC). METHODS We retrospectively analyzed 606 consecutive Chinese UTUC patients treated by RNU from 2000 to 2010. We chose an eGFR of 60 and 45 ml/min/1.73 m(2) as cut-offs for full-dose and reduced-dose AC eligibility. RESULTS Median eGFR for all patients before and after surgery was 64 and 49 ml/min/1.73 m(2) (P < 0.001). The proportion of patients ineligible to receive full-dose and reduced-dose AC changed from 42% to 74% and from 20% to 38.1%. Older age (OR = 1.007), preoperative eGFR (OR = 0.993), absence of hydronephrosis (OR = 0.801), smaller tumor size (OR = 0.962), and tumor without multifocality (OR = 0.876) were predictive for ineligibility for full-dose AC. Preoperative eGFR (OR = 0.991), absence of hydronephrosis (OR = 0.881), tumor located in renal pelvis (OR = 1.164), and smaller tumor size (OR = 0.969) could predict ineligibility for reduced-dose AC. The c-index of the two models was 0.757 and 0.836. Postoperative renal function was not associated with worse survival. CONCLUSIONS Older age, lower preoperative eGFR, smaller tumor size, tumor located in renal pelvis, and absence of hydronephrosis or multifocality were predictors of postoperative renal insufficiency.
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Lin YK, Kaag M, Raman JD. Rationale and timing of perioperative chemotherapy for upper-tract urothelial carcinoma. Expert Rev Anticancer Ther 2014; 14:543-51. [PMID: 24666189 DOI: 10.1586/14737140.2014.882774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Radical surgery alone for high-risk upper-tract urothelial carcinoma (UTUC) is often inadequate for long-term cancer control. Numerous studies implicate failure presumably attributable to metastatic disease. Therefore, multimodal therapy by way of perioperative chemotherapy is integral to improve cancer outcomes and disease-specific survival. Despite this apparent reality, there is lack of consensus regarding which patients will need additional therapy, optimal timing for delivery of agents, and specific regimens to be utilized. Progress is being made, however, to explore these issues both by extrapolation from the bladder cancer literature as well as studying outcomes from retrospective UTUC series. Prospectively accruing studies for both neoadjuvant and adjuvant chemotherapy will likely mature in the next 5 years thereby providing higher level data to better guide standard of care.
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Affiliation(s)
- Yu-Kuan Lin
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Fairey AS, Jacobsen NE, Estey E, Tanguay S, Rendon R, Bell D, Izawa J, Chin J, Kapoor A, Matsumoto E, Black P, So A, Lattouf JB, Saad F, Drachenberg D, Cagiannos I, Lacombe L, Fradet Y, Kassouf W. Comorbidity Status Does Not Independently Predict Survival Outcomes After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Eur Urol 2013; 64:518-9. [DOI: 10.1016/j.eururo.2013.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 06/08/2013] [Indexed: 10/26/2022]
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