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Berg SA, Galsky MD. Understanding Adjuvant Therapy for Upper Tract Urothelial Carcinoma. J Clin Oncol 2024; 42:1459-1461. [PMID: 38359384 DOI: 10.1200/jco.23.02679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 02/17/2024] Open
Affiliation(s)
- Stephanie A Berg
- Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Matthew D Galsky
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY
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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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Goto Y, Kanao K, Matsumoto K, Kobayashi I, Kajikawa K, Onishi M. Safety of adjuvant gemcitabine plus cisplatin chemotherapy in a patient with bilateral ureteral cancer undergoing hemodialysis. Int Cancer Conf J 2021; 10:212-216. [PMID: 34221834 PMCID: PMC8206454 DOI: 10.1007/s13691-021-00483-1] [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: 11/25/2020] [Accepted: 04/07/2021] [Indexed: 11/02/2022] Open
Abstract
An 80 year old Japanese man with bilateral ureteral cancer underwent laparoscopic bilateral nephroureterectomy and lymph-node dissection. The pathological stage of the left and right ureteral tumors was pT3pN0M0. He received two courses of adjuvant gemcitabine and cisplatin chemotherapy while undergoing hemodialysis. The standard dose of gemcitabine and 50% of the standard dose of cisplatin were administered on the same day. Hemodialysis was started 6 h after gemcitabine administration and 1 h after cisplatin administration. The side effects were evaluated according to the Common Terminology Criteria for Adverse Events v4.0. In the first course, Grade 4 side effects including leukopenia, neutropenia, and thrombocytopenia were observed. He was treated with granulocyte colony-stimulating factor and platelet transfusion. Because the second course was administered without reducing the doses, granulocyte colony-stimulating factor was administered prophylactically, and Grade 4 side effects were reduced to Grade 3. Gemcitabine plus cisplatin chemotherapy can be administered safely in a patient with advanced ureteral cancer undergoing hemodialysis by adequately managing adverse events.
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Affiliation(s)
- Yumiko Goto
- Department of Hospital Pharmacy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
| | - Kent Kanao
- Urology of Uro-Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298 Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582 Japan
| | - Ikuo Kobayashi
- Department of Urology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
| | - Keishi Kajikawa
- Department of Urology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
| | - Masafumi Onishi
- Department of Hospital Pharmacy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
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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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Ikeda M, Matsumoto K, Hirayama T, Koguchi D, Murakami Y, Matsuda D, Okuno N, Utsunomiya T, Taoka Y, Irie A, Iwamura M. Selected High-Risk Patients With Upper Tract Urothelial Carcinoma Treated With Radical Nephroureterectomy for Adjuvant Chemotherapy: A Multi-Institutional Retrospective Study. Clin Genitourin Cancer 2018; 16:e669-e675. [DOI: 10.1016/j.clgc.2017.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/21/2017] [Accepted: 10/30/2017] [Indexed: 12/30/2022]
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Danzig MR, Mallin K, McKiernan JM, Stadler WM, Sridhar SS, Morgan TM, Bochner BH, Lee CT. Prognostic importance of lymphovascular invasion in urothelial carcinoma of the renal pelvis. Cancer 2018; 124:2507-2514. [PMID: 29624636 DOI: 10.1002/cncr.31372] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 02/03/2018] [Accepted: 02/20/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The current study was conducted to assess the impact of lymphovascular invasion on the survival of patients with urothelial carcinoma of the renal pelvis. METHODS Patients with urothelial carcinoma of the renal pelvis who underwent radical nephroureterectomy from 2010 through 2015 were identified in the National Cancer Data Base. Patients were characterized according to demographic and clinical factors, including pathologic tumor stage and lymphovascular invasion. Associations with overall survival were assessed through proportional hazards regression analysis. RESULTS A total of 4177 patients were identified; 1576 had lymphovascular invasion. Patients with T3 disease and lymphovascular invasion had 5-year survival that was significantly worse than that of patients with T3 disease without lymphovascular invasion (34.7% vs 52.6; P < .001 by the log-rank test), and approached that of patients with T4 disease without lymphovascular invasion (34.7% vs 26.5%; P = .002). On multivariate analysis controlling for age, comorbidities, grade, lymph node status, surgical margin status, race, sex, and chemotherapy administration, patients with T3 disease and lymphovascular invasion also were found to have significantly worse survival compared with patients with T3 disease without lymphovascular invasion (hazard ratio, 1.7; 95% confidence interval, 1.4-1.91). CONCLUSIONS Lymphovascular invasion status is a key prognostic marker that can stratify the risk of patients with pT3 upper tract urothelial carcinoma further. Patients with this pathologic feature should be carefully considered for clinical trials exploring existing and novel therapies. Cancer 2018;124:2507-14. © 2018 American Cancer Society.
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Affiliation(s)
- Matthew R Danzig
- Division of Urology, Department of Surgery, University of Colorado, Aurora, Colorado
| | - Katherine Mallin
- American College of Surgeons, Commission on Cancer, Chicago, Illinois
| | | | - Walter M Stadler
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Srikala S Sridhar
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Bernard H Bochner
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cheryl T Lee
- Department of Urology, The Ohio State University, Columbus, Ohio
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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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8
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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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Miyake M, Tatsumi Y, Fujimoto K, Nagao K, Sakano S, Matsuyama H, Inamoto T, Azuma H, Yasumoto H, Shiina H. Changes in oncological outcomes after radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma treated in the last two decades: a retrospective analysis based on a multicenter collaborative study. Jpn J Clin Oncol 2016; 46:1148-1155. [PMID: 27576438 DOI: 10.1093/jjco/hyw128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 08/10/2016] [Accepted: 08/15/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE We investigated chronological changes in the outcomes of patients with upper urinary tract urothelial carcinoma treated in the past two decades, during which there was an important change in treatment paradigm. METHODS A retrospective review was conducted of 1180 urinary tract urothelial carcinoma patients who underwent radical nephroureterectomy in multicenter collaborative institutions between 1996 and 2015. The patients were divided into four groups according to the year when radical nephroureterectomy was performed, as follows: 1996-2000 (period 1; P1), 2001-05 (P2), 2006-10 (P3) and 2011-15 (P4). Variables including tumor grade, T and N categories, administration of perioperative chemotherapy and treatment outcomes were compared among the four groups. RESULTS There were 146 (12%), 312 (27%), 459 (39%) and 263 (22%) patients in the P1, P2, P3 and P4 groups, respectively. The proportion of patients harboring pT2/3 and Grade 3 tumors increased gradually from 42% (P1) to 58% (P4) and from 49% (P1) to 65% (P4), respectively. The 5-year disease-free survival rates were 74%, 74%, 73% and 75%, and the 5-year overall survival rates were 74%, 65%, 67% and 72% for the P1, P2, P3, and P4 groups, respectively. Multivariate analysis with adjustment for possible confounding factors revealed no significant differences in disease-specific survival, overall survival or intravesical recurrence-free survival among the four groups. CONCLUSIONS Despite advances in diagnostic instruments, surgery and systemic chemotherapy, the clinical outcome of urinary tract urothelial carcinoma after radical surgery has not significantly improved over the last two decades, and further research is therefore required.
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Affiliation(s)
- Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara
| | | | | | - Kazuhiro Nagao
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi
| | - Shigeru Sakano
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi
| | - Hideyasu Matsuyama
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi
| | - Teruo Inamoto
- Department of Urology, Osaka Medical College, Takatsuki, Osaka
| | - Haruhito Azuma
- Department of Urology, Osaka Medical College, Takatsuki, Osaka
| | - Hiroaki Yasumoto
- Department of Urology, Shimane University School of Medicine, Izumo, Shimane, Japan
| | - Hiroaki Shiina
- Department of Urology, Shimane University School of Medicine, Izumo, Shimane, Japan
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Kikuchi E, Oya M. Clinical practice patterns for upper tract urothelial carcinoma: a nationwide survey in Japan. Jpn J Clin Oncol 2016; 46:768-774. [DOI: 10.1093/jjco/hyw072] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Gakis G, Schubert T, Alemozaffar M, Bellmunt J, Bochner BH, Boorjian SA, Daneshmand S, Huang WC, Kondo T, Konety BR, Laguna MP, Matin SF, Siefker-Radtke AO, Shariat SF, Stenzl A. Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of localized high-risk disease. World J Urol 2016; 35:327-335. [DOI: 10.1007/s00345-016-1819-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/23/2016] [Indexed: 12/11/2022] Open
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12
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Mandalapu RS, Matin SF. Contemporary Evaluation and Management of Upper Tract Urothelial Cancer. Urology 2016; 94:17-23. [PMID: 26850816 DOI: 10.1016/j.urology.2015.12.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 12/16/2015] [Accepted: 12/21/2015] [Indexed: 01/05/2023]
Abstract
Radical nephroureterectomy with en bloc bladder cuff excision and regional lymphadenectomy is the gold standard for the management of high-grade and high-risk upper tract urothelial carcinomas. There are a few prospective randomized controlled studies in this uncommon and often aggressive disease to support level-1 management guidelines. However, recent developments in imaging, minimally invasive techniques, lymphatic dissemination, and bladder cancer prevention raise the hope for improved risk stratification and treatments without compromising, and hopefully improving, oncological outcomes. Multimodality approaches in terms of neoadjuvant, adjuvant topical, and systemic chemotherapeutic regimens are promising, with 2 prospective trials either open or in development.
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Affiliation(s)
| | - Surena F Matin
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
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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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Huang YC, Chen MF, Shi CS, Shindel AW, Huang CE, Pang ST, Chuang CK, Chen CS, Chang YH, Lin WY, Ho DR, Chin CC, Kuo YH, Wu CF. The Efficacy of Postoperative Adjuvant Chemotherapy for Patients with pT3N0M0 Upper Tract Urothelial Carcinoma. J Urol 2015; 194:323-9. [DOI: 10.1016/j.juro.2015.03.077] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Yun-Ching Huang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Miao-Fen Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chung-Sheng Shi
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Alan W. Shindel
- Department of Urology, University of California, Davis, California
| | - Cih-En Huang
- Department of Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - See-Tong Pang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Cheng-Keng Chuang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Shou Chen
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ying-Hsu Chang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wei-Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Dong-Ru Ho
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-Chien Chin
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yi-Hung Kuo
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ching-Fang Wu
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
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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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T Categorization of Urothelial Carcinomas of the Ureter With CT: Preliminary Study of New Diagnostic Criteria Proposed for Differentiating T2 or Lower From T3 or Higher. AJR Am J Roentgenol 2015; 204:792-7. [DOI: 10.2214/ajr.14.13167] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Dzamic Z, Milojevic B, Kajmakovic B, Grozdic Milojevic I, Bojanic N, Sipetic Grujicic S. Extraurothelial recurrence after radical nephroureterectomy: preoperative predictors and survival. Int Urol Nephrol 2015; 47:775-9. [PMID: 25772384 DOI: 10.1007/s11255-015-0946-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 03/03/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify the preoperative predictors of extraurothelial recurrence (EUR) after radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC). METHODS A single-center series of 238 consecutive patients who were treated with RNU for UTUC was evaluated. Recurrence-free probabilities and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Multivariate Cox proportional hazards regression models were used to evaluate the association between various clinicopathological factors and EUR. RESULTS The median time to EUR was 17.6 months (range 3-73 months). EUR-free survival rates at 1, 3, 5, and 7 years were 87.8, 75.2, 73.5, and 72.6%, respectively. In multivariate Cox regression analyses, tumor stage (HR 27.4; 95% CI 7.83-95.8; p = 0.0001) and lymphovascular invasion (LVI) (HR 1.53; 95% CI 1.22-3.12; p = 0.01) were independently associated with EUR. In patients with EUR, 5-year CSS estimate was 29.2%. Tumor stage (HR 14.3; 95% CI 4.55-45.2; p < 0.001) and EUR (HR 2.7; 95% CI 1.54-4.73; p = 0.001) were the only independent predictors associated with worse CSS. CONCLUSIONS EUR significantly affected the prognosis in patients with UTUC managed by RNU. Patient with EUR had a greater probability of having higher tumor stages, higher tumor grades, and positive LVI. Tumor stage and LVI were independently associated with a worse EUR-free survival.
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Affiliation(s)
- Zoran Dzamic
- Clinic of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Resavska 51, 11000, Belgrade, Serbia
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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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Oya M, Kikuchi E. Evidenced-based clinical practice guideline for upper tract urothelial carcinoma (summary--Japanese Urological Association, 2014 edition). Int J Urol 2014; 22:3-13. [PMID: 25243652 DOI: 10.1111/iju.12630] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 01/24/2023]
Abstract
Upper tract urothelial carcinoma is more rare than bladder cancer, although they are both categorized as urothelial carcinoma. Because of the low incidence, little clinical evidence is available regarding the treatment of the former. However, recently such evidence has slowly begun to accumulate. The guideline presented herein was compiled for the purpose of ensuring proper diagnosis and treatment by physicians involved in the treatment of upper tract urothelial carcinoma. We carefully selected 16 clinical questions essential for daily clinical practice and grouped them into four major categories: epidemiology, diagnosis, surgery and systemic chemotherapy/other matters. Related literature was searched using PubMed and Japan Medical Abstracts Society databases for articles published between 1987 and 2013. If the judgment was made on the basis of insufficient or inadequate evidence, the grade of recommendation was determined on the basis of committee discussions and resultant consensus statements. Here, we present a short English version of the original guideline, and overview its key clinical issues.
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Affiliation(s)
- Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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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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Zagouri F, Peroukidis S, Tzannis K, Kouloulias V, Bamias A. Current clinical practice guidelines on chemotherapy and radiotherapy for the treatment of non-metastatic muscle-invasive urothelial cancer: a systematic review and critical evaluation by the Hellenic Genito-Urinary Cancer Group (HGUCG). Crit Rev Oncol Hematol 2014; 93:36-49. [PMID: 25205597 DOI: 10.1016/j.critrevonc.2014.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/30/2014] [Accepted: 08/14/2014] [Indexed: 12/15/2022] Open
Abstract
Radical cystectomy is the treatment of choice in localized muscle-invasive urothelial cancer. Nevertheless, relapses are frequent and systemic chemotherapy has been employed in order to reduce this risk. In addition, bladder preservation strategies are appealing. During the last decade, there has been a difficulty in conducting and completing large-scale trials in urothelial cancer. This has resulted in relatively few changes in the existing guidelines. Recent studies have created renewed interest in certain fields, such as the role of chemo-radiotherapy and management of unfit patients. In addition, application of certain guidelines has been limited in everyday practice. We conducted a systematic review of the existing guidelines and recent randomized trials not included in these guidelines, and developed a treatment algorithm, regarding non-surgical therapies for non-metastatic, muscle-invasive urothelial cancer based predominantly on patients' fitness for the available therapeutic modalities.
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Affiliation(s)
- F Zagouri
- Department of Clinical Therapeutics, University of Athens, Athens, Greece
| | - S Peroukidis
- Medical Oncology Department, University of Patras, Rion, Greece
| | - K Tzannis
- Department of Clinical Therapeutics, University of Athens, Athens, Greece
| | - V Kouloulias
- Radiotherapy Department, Attikon University Hospital, Athens, Greece
| | - A Bamias
- Department of Clinical Therapeutics, University of Athens, Athens, Greece.
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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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Bruzzi M, Le Goux C, Pignot G, Amsellem-Ouazana D, Vieillefond A, Patard JJ, Zerbib M. [Pronostic value of parenchyma renal invasion of pT3 upper tract urinary carcinoma]. Prog Urol 2014; 24:556-62. [PMID: 24975790 DOI: 10.1016/j.purol.2013.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 12/01/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Upper tract urinary carcinoma (UTUC) pT3 tumors are a heterogeneous entity including tumors invading the renal parenchyma, tumors with peripelvic fat invasion or peri-ureteral fat invasion. The aim of this study was to evaluate the prognostic significance of these three different groups of pT3 tumors. PATIENTS AND METHODS Between 1998 and 2012, 205 patients with UTUC were operated in two centers, including 52 patients with pT3 tumor stage. pT3 tumors were divided into three groups: peri-ureteral fat invasion (pT3U, n = 16), peripelvic fat invasion (pT3G, n = 21), and renal parenchyma invasion (pT3P, n = 15). The prognostic significance of the type of tumor infiltration was evaluated on specific and disease-free survival. RESULTS Median follow-up was 18.9 months [6-133.4]. In univariate analysis, renal parenchyma invasion was associated with a better prognostic in both specific (P = 0.026) and disease-free survival (P = 0.031) compared with peripelvic or peri-ureteral fat invasion. Mutivariate analysis retained the pT3 subgroup as an independant prognostic factor in both specific and disease-free survival (P = 0.02). CONCLUSION pT3 tumors with renal parenchyma invasion had a better prognosis than those with peripelvic or peri-ureteral fat invasion. The heterogeneity of the pT3 group should be taken into account to improve the care of patients.
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Affiliation(s)
- M Bruzzi
- Service d'urologie, hôpital Bicêtre, université Paris-Sud Paris XI, 94270 Le Kremlin-Bicêtre, France
| | - C Le Goux
- Service d'urologie, hôpital Bicêtre, université Paris-Sud Paris XI, 94270 Le Kremlin-Bicêtre, France.
| | - G Pignot
- Service d'urologie, hôpital Bicêtre, université Paris-Sud Paris XI, 94270 Le Kremlin-Bicêtre, France
| | - D Amsellem-Ouazana
- Service d'urologie, hôpital Cochin, université Paris Descartes Paris V, 75014 Paris, France
| | - A Vieillefond
- Service d'anatomopathologie, hôpital Cochin, 75014 Paris, France
| | - J-J Patard
- Service d'urologie, hôpital Bicêtre, université Paris-Sud Paris XI, 94270 Le Kremlin-Bicêtre, France
| | - M Zerbib
- Service d'urologie, hôpital Cochin, université Paris Descartes Paris V, 75014 Paris, France
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Kluth LA, Xylinas E, Kent M, Hagiwara M, Kikuchi E, Ikeda M, Matsumoto K, Dalpiaz O, Zigeuner R, Aziz A, Fritsche HM, Deliere A, Raman JD, Bensalah K, Al-Matar B, Gakis G, Novara G, Klatte T, Remzi M, Comploj E, Pycha A, Rouprêt M, Tagawa ST, Chun FKH, Scherr DS, Vickers AJ, Shariat SF. Predictors of survival in patients with disease recurrence after radical nephroureterectomy. BJU Int 2014; 113:911-7. [DOI: 10.1111/bju.12369] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Luis A. Kluth
- Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
- Department of Urology; University Medical-Center Hamburg-Eppendorf; Hamburg Germany
| | - Evanguelos Xylinas
- Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
- Department of Urology; Cochin Hospital, Assistance Publique-Hopitaux de Paris, Paris Descartes University; Paris France
| | - Matthew Kent
- Department of Epidemiology and Biostatistics; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | - Masayuki Hagiwara
- Department of Urology; Keio University School of Medicine; Shinjuku-ku Tokyo Japan
| | - Eiji Kikuchi
- Department of Urology; Keio University School of Medicine; Shinjuku-ku Tokyo Japan
| | - Masaomi Ikeda
- Department of Urology; Kitasato University School of Medicine; Minami-ku Sagamihara Kanagawa Japan
| | - Kazumasa Matsumoto
- Department of Urology; Kitasato University School of Medicine; Minami-ku Sagamihara Kanagawa Japan
| | - Orietta Dalpiaz
- Department of Urology; Medical University of Graz; Graz Austria
| | | | - Atiqullah Aziz
- Department of Urology; Caritas St. Josef Medical Centre; University of Regensburg; Regensburg Germany
| | - Hans-Martin Fritsche
- Department of Urology; Caritas St. Josef Medical Centre; University of Regensburg; Regensburg Germany
| | - Amanda Deliere
- Division of Urology; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Jay D. Raman
- Division of Urology; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Karim Bensalah
- Department of Urology; Centre Hospitalier Universitaire de Rennes; Rennes France
| | - Bikheet Al-Matar
- Department of Urology; University Medical Hospital of Tuebingen; Tuebingen Germany
| | - Georgios Gakis
- Department of Urology; University Medical Hospital of Tuebingen; Tuebingen Germany
| | - Giacomo Novara
- Department of Surgical, Oncological and Gastroenterologic Sciences; Urology Clinic; University of Padua; Padua Italy
| | - Tobias Klatte
- Department of Urology; Medical University of Vienna; Vienna Austria
| | - Mesut Remzi
- Department of Urology; Landesklinikum Korneuburg; Korneuburg Austria
| | - Evi Comploj
- Department of Urology; General Hospital of Bolzano; Bolzano Italy
| | - Armin Pycha
- Department of Urology; General Hospital of Bolzano; Bolzano Italy
| | - Morgan Rouprêt
- Academic Department of Urology of la Pitié-Salpétrière; Assistance Publique-Hôpitaux de Paris; University Paris VI, Faculté de médecine Pierre et Marie Curie; Paris France
| | - Scott T. Tagawa
- Division of Medical Oncology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
| | - Felix K.-H. Chun
- Department of Urology; University Medical-Center Hamburg-Eppendorf; Hamburg Germany
| | - Douglas S. Scherr
- Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
| | - Andrew J. Vickers
- Department of Epidemiology and Biostatistics; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | - Shahrokh F. Shariat
- Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
- Division of Medical Oncology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
- Department of Urology; Medical University of Vienna; Vienna Austria
- Department of Urology; UT Southwestern; Dallas TX USA
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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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Porten S, Siefker-Radtke AO, Xiao L, Margulis V, Kamat AM, Wood CG, Jonasch E, Dinney CPN, Matin SF. Neoadjuvant chemotherapy improves survival of patients with upper tract urothelial carcinoma. Cancer 2014; 120:1794-9. [PMID: 24633966 DOI: 10.1002/cncr.28655] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/05/2014] [Accepted: 02/07/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND High-grade upper tract urothelial carcinoma (UTUC) is frequently upstaged after surgery and is associated with uniformly poor survival. Neoadjuvant chemotherapy may offer a way to improve clinical outcomes. The authors compared the survival rates of patients with UTUC who received neoadjuvant chemotherapy before surgery with the rates among patients who did not. METHODS A retrospective review was conducted of patients with high-risk UTUC who received neoadjuvant chemotherapy followed by surgery from 2004 to 2008 (study group) compared with a matched cohort who underwent initial surgery from 1993 to 2003 (control group). Fisher exact tests, Wilcoxon rank-sum tests, and Kaplan-Meier methods were used. The log-rank test and Cox proportional-hazards models were used to evaluate the association of the 2 outcomes with patient, treatment, and tumor characteristics in univariate and multivariate models. RESULTS Of 112 patients, there were 31 in the study group and 81 in the control group. Patients who received neoadjuvant chemotherapy had improved overall survival (OS) and disease-specific survival (DSS) with a 5-year DSS rate of 90.1% and a 5-year OS rate of 80.2% versus DSS and OS rates of 57.6% for those who underwent initial surgery (P = .0204 and P = .0015, respectively). In multivariate analyses, the neoadjuvant group had a lower risk of mortality (OS: hazard ratio, 0.42 [P = .035]; DSS: hazard ratio, 0.19 [P = .006]). CONCLUSIONS Neoadjuvant chemotherapy improved the survival of patients with UTUC compared with a matched historic cohort of patients who underwent initial surgery. Patients with high-risk UTUC should be considered for neoadjuvant chemotherapy in view of the limited opportunity to administer effective cisplatin-based chemotherapy after nephroureterectomy.
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Affiliation(s)
- Sima Porten
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Raman JD, Lin YK, Kaag M, Atkinson T, Crispen P, Wille M, Smith N, Hockenberry M, Guzzo T, Peyronnet B, Bensalah K, Simhan J, Kutikov A, Cha E, Herman M, Scherr D, Shariat SF, Boorjian SA. High rates of advanced disease, complications, and decline of renal function after radical nephroureterectomy. Urol Oncol 2014; 32:47.e9-14. [DOI: 10.1016/j.urolonc.2013.06.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 06/27/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
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Gayed BA, Thoreson GR, Margulis V. The Role of Systemic Chemotherapy in Management of Upper Tract Urothelial Cancer. Curr Urol Rep 2013; 14:94-101. [DOI: 10.1007/s11934-013-0307-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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The potential use of primary human upper urinary tract urothelial cell carcinoma (UUT-UCC) cultured cells for prognostic indicators and chemosensitivity test. ACTA ACUST UNITED AC 2012; 65:703-8. [PMID: 23069010 DOI: 10.1016/j.etp.2012.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/22/2012] [Accepted: 09/17/2012] [Indexed: 11/20/2022]
Abstract
Upper urinary tract urothelial cell carcinoma (UUT-UCC) is a rare yet aggressive urologic tumor with a high rate of recurrence and metastasis, resulting in high mortality. Chemotherapy has been used to prevent recurrence and treat metastatic UUT-UCCs. Although UUT-UCC is sensitive to chemotherapy, the patients' responses to therapy vary and the therapy outcome is unpredictable. Therefore, the identification of patients who are at high risk of failure in chemotherapy is important for accurate prognostication, patient counseling, and better therapy. We have obtained cells from UUT-UCC tumor tissues after surgery and established individual primary cultured cell lines, which were used to evaluate E-cadherin and Ki-67 proliferation marker expression and their chemosensitivity to chemotherapeutic drugs. Differential Ki-67 expression and chemosensitivity were observed in these primary cultured cell lines, suggesting these types of UUT-UCC cell lines could provide a platform for determining prognostic makers and evaluating the efficacy of chemotherapy. In conclusion, primary cultured cell lines from individual patients will be a great tool for evaluating and determining each individual's personalized chemotherapy course and for testing and screening new chemotherapeutic agents against UUT-UCCs.
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Gunay LM, Akdogan B, Koni A, Inci K, Bilen CY, Ozen H. Upper urinary tract transitional cell carcinoma: is there a best? Clin Genitourin Cancer 2012; 11:39-44. [PMID: 23063580 DOI: 10.1016/j.clgc.2012.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 07/22/2012] [Accepted: 08/16/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to determine the prognostic and risk factors for bladder and systemic recurrence after nephroureterectomy (NU) in patients with upper urinary tract (UUT) transitional cell carcinoma (TCC). PATIENTS AND METHODS Data from 101 patients with nonmetastatic UUT TCC who underwent NU between 1987 and 2009 were retrospectively evaluated. Kaplan-Meier curves for sex, age, anemia, smoking, stone disease, or history of bladder tumor, primary tumor localization, multiplicity, and disease stage and grade were constructed to predict 5-year recurrence-free survival (RFS). Multivariate Cox regression analysis was used to identify independent risk factors for recurrence. RESULTS Bladder, distant, and local recurrence rates at a mean of 56.19 ± 5.30 months after NU were 38.5%, 19.8%, and 7.9%, respectively. Univariate analysis showed that among the patients with bladder recurrence, female patients had significantly lower 5-year RFS than did male patients (34.7% ± 0.13% vs. 62.4% ± 0.06%, P = .038); however multivariate analysis showed that both female sex and a history of smoking were independent risk factors for bladder recurrence (odds ratio [OR], 4.22; 95% confidence interval [CI], 1.56-11.4; P = 0.005 and OR, 2.84; 95% CI, 1.1-7.4; P = .032, respectively). Univariate analysis showed that among the patients with local and distant recurrence, anemia, a positive history of bladder tumor, localization of the primary tumor, multiplicity, disease stage, and tumor grade significantly affected RFS, whereas primary tumor stage and grade were the only independent risk factors for 5-year RFS (OR, 4.48; 95% CI, 1.45-13.79; P = .009 and OR, 5.82; 95% CI, 2.08-16.26; P = .001, respectively). CONCLUSION Female sex and a history of smoking were independent risk factors for bladder recurrence after NU. Such patients should be monitored closely using cystoscopy and urine cytologic examination. Invasive and higher grade UUT TCC was associated with worse local or systemic RFS.
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Prognostic Factors in Upper Urinary Tract Urothelial Carcinomas: A Comprehensive Review of the Current Literature. Eur Urol 2012; 62:100-14. [DOI: 10.1016/j.eururo.2012.02.030] [Citation(s) in RCA: 307] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 02/14/2012] [Indexed: 12/12/2022]
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Berz D, Rizack T, Weitzen S, Mega A, Renzulli J, Colvin G. Survival of patients with squamous cell malignancies of the upper urinary tract. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2011; 6:11-8. [PMID: 22253551 PMCID: PMC3256977 DOI: 10.4137/cmo.s8103] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Carcinomas of the renal pelvis and ureter are rare diseases, accounting for only about 1% of all urogenital malignancies. Previous reports suggest that squamous cell histology is associated with inferior survival. We present the largest population based analysis to date of survival in patients with upper urinary tract malignancies. Methods We analyzed the Surveillance, Epidemiology and End Results database for cancer specific survival rates in patients with renal pelvis and ureteral malignancies who were diagnosed between 1973 and 2003 in the SEER catchment geographic areas. The primary exposure of interest was the underlying histology, squamous cell versus transitional cell differentiation. We performed descriptive statistics, non parametric survival analysis, and cox proportional hazard analysis. Results We identified 13,213 eligible patients, 7,716 renal pelvis and 5,497 ureteral carcinomas. Among this cohort, 179 patients had squamous cell carcinoma (SCC), 12,395 had transitional cell carcinoma (TCC), including 121 papillary, and 619 had other histologies. Overall, patients with SCC histology fared worse. The median overall survival time was 10 months for SCC and 63 months for TCC. The cox analysis revealed a HR 3.7 (95% CI 3.0–4.5) for SCC when compared to TCC and corrected for decade of diagnosis, age, gender, prior treatment, and race. The difference between the two groups was entirely attributable to survival differences in patients with loco-regional disease. However, when stratified by lymph node involvement this difference disappeared for patients with locally involved lymph nodes (P = 0.84) and for patients with clear lymph nodes (P = 0.92). Conclusions SCCs of the upper urinary tract present at a higher clinical stage and appear to represent more aggressive disease when compared to other histologies. However, when appropriately staged according to lymph node status, the survival of TCC and SCC of the upper urinary tract is identical when compared stage by stage.
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Kawashima A, Nakai Y, Nakayama M, Ujike T, Tanigawa G, Ono Y, Kamoto A, Takada T, Yamaguchi Y, Takayama H, Nishimura K, Nonomura N, Tsujimura A. The result of adjuvant chemotherapy for localized pT3 upper urinary tract carcinoma in a multi-institutional study. World J Urol 2011; 30:701-6. [DOI: 10.1007/s00345-011-0775-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Accepted: 09/24/2011] [Indexed: 11/30/2022] Open
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Kwan A, Mazhar D. Role of chemotherapy in upper urinary tract urothelial cell cancers. Future Oncol 2011; 7:1067-75. [PMID: 21919694 DOI: 10.2217/fon.11.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Urothelial cancers of the upper urinary tract are uncommon and often treated in a similar fashion to lower urinary tract urothelial malignancies. Currently, there are no clear guidelines on the use of systemic chemotherapy for upper urinary tract urothelial cancers either in the perioperative setting or in cases of advanced disease. The aim of this article is to review the key studies in upper urinary tract cancers to help develop an understanding about the optimal management and suggest areas for future research.
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Affiliation(s)
- Amy Kwan
- Addenbrooke's Hospital, Hill's Road, Cambridge CB2 0QQ, UK
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Chen B, Zeng ZC, Wang GM, Zhang L, Lin ZM, Sun LA, Zhu TY, Wu LL, Zhang JY, Ji Y. Radiotherapy may improve overall survival of patients with T3/T4 transitional cell carcinoma of the renal pelvis or ureter and delay bladder tumour relapse. BMC Cancer 2011; 11:297. [PMID: 21756352 PMCID: PMC3155495 DOI: 10.1186/1471-2407-11-297] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 07/14/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since transitional cell carcinoma (TCC) of the upper urinary tract is a relatively uncommon malignancy, the role of adjuvant radiotherapy is unknown. METHODS We treated 133 patients with TCC of the renal pelvis or ureter at our institution between 1998 and 2008. The 67 patients who received external beam radiotherapy (EBRT) following surgery were assigned to the radiation group (RT). The clinical target volume included the renal fossa, the course of the ureter to the entire bladder, and the paracaval and para-aortic lymph nodes, which were at risk of harbouring metastatic disease in 53 patients. The tumour bed or residual tumour was targeted in 14 patients. The median radiation dose administered was 50 Gy. The 66 patients who received intravesical chemotherapy were assigned to the non-radiation group (non-RT). RESULTS The overall survival rates for the RT and non-RT groups were not significantly different (p = 0.198). However, there was a significant difference between the survival rates for these groups based on patients with T3/T4 stage cancer. A significant difference was observed in the bladder tumour relapse rate between the irradiated and non-irradiated bladder groups (p = 0.004). Multivariate analysis indicated that improved overall survival was associated with age < 60 years, T1 or T2 stage, absence of synchronous LN metastases, and EBRT. Acute gastrointestinal and bladder reactions were the most common symptoms, but mild non-severe (> grade 3) hematologic symptoms also occurred. CONCLUSION EBRT may improve overall survival for patients with T3/T4 cancer of the renal pelvis or ureter and delay bladder tumour recurrence in all patients.
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Affiliation(s)
- Bing Chen
- Department of Radiation Oncology of Zhongshan hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, China
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Vassilakopoulou M, de la Motte Rouge T, Colin P, Ouzzane A, Khayat D, Dimopoulos MA, Papadimitriou CA, Bamias A, Pignot G, Nouhaud FX, Hurel S, Guy L, Bigot P, Roumiguié M, Rouprêt M. Outcomes after adjuvant chemotherapy in the treatment of high-risk urothelial carcinoma of the upper urinary tract (UUT-UC): results from a large multicenter collaborative study. Cancer 2011; 117:5500-8. [PMID: 21638278 DOI: 10.1002/cncr.26172] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 02/24/2011] [Accepted: 03/03/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND Urothelial carcinoma of the upper urinary tract (UUT-UC) was a rare, aggressive urologic cancer with a propensity for multifocality, local recurrence, and metastasis. High-risk patients had poor outcomes. Because of the rarity of these tumors, randomized clinical trials and data regarding adjuvant chemotherapy in locally advanced tumors are currently unavailable. Our objective was to assess the effect of adjuvant chemotherapy and the impact of potential prognostic factors on survival in high-risk, postsurgical UUT-UC patients. METHODS Using a multi-institutional, international retrospective database, identified were 627 patients with high risk UUT-UCs (pT3N0, pT4N0 and/or N+ and/or M+) who underwent surgical removal. Only patients who received adjuvant chemotherapy were included. RESULTS Overall, 140 patients (22.6%) with a median age of 67 years were included. The median follow-up was 22.5 months. The 5-year, overall survival for the entire cohort was 43%, the 5-year recurrence-free survival was 54%, and metastasis-free survival was 53% at 5 years. Positive surgical margins were an independent prognostic factor for recurrence (P = .06), cancer-specific mortality (P = .05), and overall mortality (P = .02) of any cause. Adjuvant chemotherapy was not linked with overall or cancer-specific survival in patients with high risk disease (adjuvant chemotherapy [n = 140] vs no treatment [n = 487]) (P >.5). CONCLUSIONS Adjuvant postoperative chemotherapy did not offer any significant benefit to overall survival in our population. Additional data were necessary, and studies enrolling patients at high risk in clinical trials investigating neoadjuvant chemotherapy in conjunction with chemotherapy should have been highly encouraged.
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Affiliation(s)
- Maria Vassilakopoulou
- Academic Department of Medical Oncology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
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Ito Y, Kikuchi E, Tanaka N, Miyajima A, Mikami S, Jinzaki M, Oya M. Preoperative hydronephrosis grade independently predicts worse pathological outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma. J Urol 2011; 185:1621-6. [PMID: 21419429 DOI: 10.1016/j.juro.2010.12.035] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Indexed: 12/15/2022]
Abstract
PURPOSE We analyzed the prognostic impact of hydronephrosis grade on disease specific survival and evaluated whether hydronephrosis grade could preoperatively predict worse pathological outcomes in cases of upper tract urothelial carcinoma treated surgically. MATERIALS AND METHODS We identified and retrospectively reviewed the records of 91 patients who were evaluated by multidetector computerized tomography and/or magnetic resonance imaging preoperatively, and treated with nephroureterectomy at our institution from 2000 to 2009. Ipsilateral hydronephrosis was graded 0 to 4 by 2 urological radiologists blinded to clinical outcomes. We analyzed the associations between hydronephrosis grade, and pathological findings and patient outcomes. RESULTS Preoperatively 67 patients (73.6%) had ipsilateral hydronephrosis. Grade was 1 to 4 in 3 (3.3%), 17 (18.7%), 23 (25.3%) and 24 cases (26.4%), respectively. Higher hydronephrosis grade was significantly associated with a ureteral tumor (p = 0.0307), higher pT stage (p = 0.0002) and lymphovascular invasion (p = 0.0014). Higher hydronephrosis grade was not associated with disease specific or metastasis-free survival. On preoperative multivariate analysis high hydronephrosis grade predicted pathological T stage (T3 or greater) (HR 4.98, p = 0.0228), positive lymphovascular invasion (HR 6.37, p = 0.0022) and grade 3 (HR 2.98, p = 0.0311). CONCLUSIONS On image analysis preoperative hydronephrosis grade was associated with features of aggressive disease and predicted an advanced pathological outcome in patients with upper tract urothelial carcinoma. This information could prove useful to select candidates for neoadjuvant chemotherapy and make decisions concerning surgical options.
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Affiliation(s)
- Yujiro Ito
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Pflugfelder A, Eigentler TK, Keim U, Weide B, Leiter U, Ikenberg K, Berneburg M, Garbe C. Effectiveness of carboplatin and paclitaxel as first- and second-line treatment in 61 patients with metastatic melanoma. PLoS One 2011; 6:e16882. [PMID: 21359173 PMCID: PMC3040212 DOI: 10.1371/journal.pone.0016882] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 01/06/2011] [Indexed: 11/25/2022] Open
Abstract
Background Patients with metastatic melanoma have a very unfavorable prognosis with few therapeutic options. Based on previous promising experiences within a clinical trial involving carboplatin and paclitaxel a series of advanced metastatic melanoma patients were treated with this combination. Methods Data of all patients with cutaneous metastatic melanoma treated with carboplatin and paclitaxel (CP) at our institution between October 2005 and December 2007 were retrospectively evaluated. For all patients a once-every-3-weeks dose-intensified regimen was used. Overall and progression free survival were calculated using the method of Kaplan and Meier. Tumour response was evaluated according to RECIST criteria. Results 61 patients with cutaneous metastatic melanoma were treated with CP. 20 patients (85% M1c) received CP as first-line treatment, 41 patients (90.2% M1c) had received at least one prior systemic therapy for metastatic disease. Main toxicities were myelosuppression, fatigue and peripheral neuropathy. Partial responses were noted in 4.9% of patients, stable disease in 23% of patients. No complete response was observed. Median progression free survival was 10 weeks. Median overall survival was 31 weeks. Response, progression-free and overall survival were equivalent in first- and second-line patients. 60 patients of 61 died after a median follow up of 7 months. Median overall survival differed for patients with controlled disease (PR+SD) (49 weeks) compared to patients with progressive disease (18 weeks). Conclusions Among patients with metastatic melanoma a subgroup achieved disease control under CP therapy which may be associated with a survival benefit. This potential advantage has to be weighed against considerable toxicity. Since response rates and survival were not improved in previously untreated patients compared to pretreated patients, CP should thus not be applied as first-line treatment.
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Affiliation(s)
- Annette Pflugfelder
- Department of Dermatology, Center for Dermatooncology, University Hospital Tuebingen, Tuebingen, Germany.
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Sundi D, Svatek RS, Margulis V, Wood CG, Matin SF, Dinney CP, Kamat AM. Upper tract urothelial carcinoma: impact of time to surgery. Urol Oncol 2010; 30:266-72. [PMID: 20869888 DOI: 10.1016/j.urolonc.2010.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 04/01/2010] [Accepted: 04/03/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Patients diagnosed with upper tract urothelial carcinoma (UTUC) sometimes experience a delay from diagnosis to extirpative surgery (nephroureterectomy or ureterectomy) as a result of attempted endoscopic management and/or neoadjuvant chemotherapy. The purpose of this analysis is to examine the impact of such delay on survival outcomes. METHODS An IRB-approved retrospective review identified consecutive patients undergoing extirpative surgery for UTUC treated at a single institution between 1990 and 2007. 240 patients with non-metastatic disease represented both primarily-presenting and referred patients. Patients in the "early" surgery group underwent extirpative surgery <3 months after diagnosis and patients in the "delayed" surgery group underwent surgery ≥ 3 months after diagnosis. Timing to surgery was at the discretion of individual patient-surgeon decision-making. Analyses and measurements were univariate and multivariate models correlating death from disease with clinico-pathologic parameters, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) in the "early" and "delayed" surgery groups. RESULTS 186 patients underwent early surgery and 54 patients underwent delayed surgery. Median follow-up for all patients was 29 months. The 5-year CSS were 72% and 71% for the early versus late groups, respectively (P = 0.39) and corresponding 5-year OS rates were 60% and 69%, respectively (P = 0.69). Delay in surgery was not associated with a worse outcome, even following adjustment for potential confounders. The most common factor contributing to delayed surgery in our cohort was administration of neoadjuvant chemotherapy (50%), which did not impact survival. Limitations included a median follow-up of 19 months in the neoadjuvant group; and the requirement to analytically group pathologic high-stage and low-stage disease, which reflects challenges inherent to current clinical staging. CONCLUSIONS Our results show no difference in survival between patients undergoing early versus delayed extirpative surgery for UTUC, suggesting the feasibility of delayed surgery in appropriately selected patients. Only prospective validation of delayed surgery can guarantee its safety.
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Affiliation(s)
- Debasish Sundi
- Department of Urologic Oncology, M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Expression of parvin-beta is a prognostic factor for patients with urothelial cell carcinoma of the upper urinary tract. Br J Cancer 2010; 103:852-60. [PMID: 20736946 PMCID: PMC2966628 DOI: 10.1038/sj.bjc.6605835] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Parvin-β (ParvB), a potential tumour suppressor gene, is a focal adhesion protein. We evaluated the role of ParvB in the upper urinary tract urothelial cell carcinoma (UUT-UC). Methods: ParvB mRNA and proteins levels in UUT-UC tissue were investigated by quantitative real-time polymerase chain reaction and western blot analysis, respectively. In addition, the expression of ParvB in tissues from patients with UUT-UC at different stages was evaluated by immunohistochemistry. Furthermore, biological functions of ParvB in urothelial cancer cells were investigated using a doxycycline-inducible overexpression system and siRNA. Results: Western blot and mRNA analysis showed downregulation of ParvB expression in frozen UUT-UC tissue. Immunohistochemistry revealed high staining intensity of ParvB in normal urothelium, which decreased markedly at advanced stages of UUT-UC (P=0.0000). Moreover, ParvB was an independent prognostic indicator for disease-specific survival of patients with UUT-UC. Functional assays indicated that overexpression of ParvB in an urothelial cancer cell line resulted in decreased cell growth rate and ability to migrate. In contrast, knockdown of ParvB expression increased cell migration ability. Conclusions: Downregulation of ParvB expression significantly increased urothelial cancer cell growth and migration. Downexpression of ParvB level in UUT-UC correlated with tumour stage, and was an independent unfavourable prognostic factor for disease-specific survival of patients with UUT-UC.
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Kaag MG, O'Malley RL, O'Malley P, Godoy G, Chen M, Smaldone MC, Hrebinko RL, Raman JD, Bochner B, Dalbagni G, Stifelman MD, Taneja SS, Huang WC. Changes in renal function following nephroureterectomy may affect the use of perioperative chemotherapy. Eur Urol 2010; 58:581-7. [PMID: 20619530 DOI: 10.1016/j.eururo.2010.06.029] [Citation(s) in RCA: 201] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 06/16/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nephroureterectomy alone fails to adequately treat many patients with advanced upper tract urothelial carcinoma (UTUC). Perioperative platinum-based chemotherapy has been proposed but requires adequate renal function. OBJECTIVE Our aim was to determine whether the ability to deliver platinum-based chemotherapy following nephroureterectomy is affected by postoperative changes in renal function. DESIGN, SETTINGS, AND PARTICIPANTS We retrospectively reviewed data on 388 patients undergoing nephroureterectomy for UTUC between 1991 and 2009. Four institutions were included. INTERVENTION All patients underwent nephroureterectomy. MEASUREMENTS All patients had serum creatinine measured before and after surgery. The value closest to 3 mo after surgery was taken as the postoperative value (range: 2-52 wk). Estimated glomerular filtration rate (eGFR) was calculated using the abbreviated Modification of Diet in Renal Disease study equation. eGFR values before and after surgery were compared using the paired t test. We chose an eGFR of 45 and 60 ml/min per 1.73 m(2) as possible cut-offs for chemotherapy eligibility and compared eligibility before and after surgery using the chi-square test. RESULTS AND LIMITATIONS Our cohort of 388 patients included 233 men (60%) with a median age of 70 yr. Mean eGFR decreased by 24% after surgery. Using a cut-off of 60 ml/min per 1.73 m(2), 49% of patients were eligible for chemotherapy before surgery, but only 19% of patients remained eligible postoperatively. Using a cut-off of 45 ml/min per 1.73 m(2), 80% of patients were eligible preoperatively, but only 55% remained eligible after surgery. This distribution persisted when we limited the analysis to patients with advanced pathologic stage (T3 or higher). Patients older than the median age of 70 yr were more likely to be ineligible for chemotherapy both pre- and postoperatively by either definition, and they were significantly more likely to have an eGFR <45 ml/min per 1.73 m(2) postoperatively, regardless of their starting eGFR. This study is limited by its retrospective nature, and there was some variability in the timing of postoperative serum creatinine measurements. CONCLUSIONS eGFR is significantly diminished after nephroureterectomy, particularly in elderly patients. These changes in renal function likely affect eligibility for adjuvant cisplatin-based therapy. Accordingly, we suggest strong consideration of neoadjuvant regimens.
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Affiliation(s)
- Matthew G Kaag
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Lughezzani G, Jeldres C, Isbarn H, Sun M, Shariat SF, Widmer H, Arjane P, Graefen M, Perrotte P, Montorsi F, Karakiewicz PI. Temporal stage and grade migration in surgically treated patients with upper tract urothelial carcinoma. BJU Int 2009; 105:799-804. [PMID: 19725824 DOI: 10.1111/j.1464-410x.2009.08818.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
STUDY TYPE Therapy (individual cohort). LEVEL OF EVIDENCE 2b. OBJECTIVE To examine the temporal trends in stage and grade at presentation, as well as cancer-specific mortality (CSM) rates, in surgically treated patients with upper tract urothelial carcinoma (UTUC), as few population-based studies addressed contemporary cancer-control outcomes in patients with UTUC. PATIENTS AND METHODS Within the Surveillance, Epidemiology and End Results (SEER) database, we identified 4915 patients diagnosed with UTUC between 1983 and 2004, who had either a nephroureterectomy (NU) or a segmental ureterectomy (SU). Patients were divided into four groups according to the year-of-surgery quartiles. The chi-square test and the chi-square trend test were used for comparison of proportions and trends over time. Kaplan-Meier plots were used to graphically depict CSM rates. Multivariable Cox regression models were used to test the effect of the year-of-surgery quartiles on CSM. Covariates consisted of SEER stage, tumour grade, age, race, primary tumour site, type of surgery, and SEER registries. RESULTS Of 4915 assessable patients, 1316, 1328, 1146 and 1125 were, respectively, treated in 1983-1988, 1989-94, 1995-99 and 2000-2004. Of those, 4430 had a NU and 485 had a SU. The rates of non-localized stage and of grade III-IV disease at surgery increased, respectively, from 49.8% to 69.5% (P < 0.001) and 45.7 to 70.2% (P < 0.001) during the study period. CSM rates at 4 years after surgery reflected the temporal stage and grade differences, and increased from 18.2 to 23.9% (P = 0.03) between 1983-1988 and 2000-2004. In multivariable analyses, when stage and grade were taken into account, most contemporary patients showed more favourable CSM rates than their historic counterparts (hazard ratio 0.7, P = 0.02). CONCLUSIONS We report a stage and grade migration at NU or SU towards more aggressive disease among surgically treated patients between 1983 and 2004. Despite this observation, the CSM rates of contemporary patients have not worsened, which validates the role of NU and SU as effective treatments for UTUC.
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Hellenthal NJ, Shariat SF, Margulis V, Karakiewicz PI, Roscigno M, Bolenz C, Remzi M, Weizer A, Zigeuner R, Bensalah K, Ng CK, Raman JD, Kikuchi E, Montorsi F, Oya M, Wood CG, Fernandez M, Evans CP, Koppie TM. Adjuvant chemotherapy for high risk upper tract urothelial carcinoma: results from the Upper Tract Urothelial Carcinoma Collaboration. J Urol 2009; 182:900-6. [PMID: 19616245 DOI: 10.1016/j.juro.2009.05.011] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Indexed: 12/15/2022]
Abstract
PURPOSE There is relatively little literature on adjuvant chemotherapy after radical nephroureterectomy in patients with upper tract urothelial carcinoma. We determined the incidence of adjuvant chemotherapy in high risk patients and the ensuing effect on overall and cancer specific survival. MATERIALS AND METHODS Using an international collaborative database we identified 1,390 patients who underwent nephroureterectomy for nonmetastatic upper tract urothelial carcinoma between 1992 and 2006. Of these cases 542 (39%) were classified as high risk (pT3N0, pT4N0 and/or lymph node positive). These patients were divided into 2 groups, including those who did and did not receive adjuvant chemotherapy, and stratified by gender, age group, performance status, and tumor grade and stage. Cox proportional hazard modeling and Kaplan-Meier analysis were used to determine overall and cancer specific survival in the cohorts. RESULTS Of high risk patients 121 (22%) received adjuvant chemotherapy. Adjuvant chemotherapy was more commonly administered in the context of increased tumor grade and stage (p <0.001). Median survival in the entire cohort was 24 months (range 0 to 231). There was no significant difference in overall or cancer specific survival between patients who did and did not receive adjuvant chemotherapy. However, age, performance status, and tumor grade and stage were significant predictors of overall and cancer specific survival. CONCLUSIONS Adjuvant chemotherapy is infrequently used to treat high risk upper tract urothelial carcinoma after nephroureterectomy. Despite this finding it appears that adjuvant chemotherapy confers minimal impact on overall or cancer specific survival in this group.
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Lee SE, Byun SS, Park YH, Chang IH, Kim YJ, Hong SK. Adjuvant Chemotherapy in the Management of pT3N0M0 Transitional Cell Carcinoma of the Upper Urinary Tract. Urol Int 2009; 77:22-6. [PMID: 16825811 DOI: 10.1159/000092930] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Accepted: 11/15/2005] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We investigate the efficacy of postoperative adjuvant chemotherapy for locally advanced, but lymph node negative, pathologic stage T3 transitional cell carcinoma (TCC) of the upper urinary tract. PATIENTS AND METHODS A retrospective study on 27 patients who had undergone radical nephroureterectomy with regional lymphadenectomy for pT3N0M0 primary upper urinary tract TCC at our institution from 1996 to 2001 was performed. Among the 27 patients, 16 also received adjuvant chemotherapy following surgery (adjuvant group), whereas the other 11 patients did not (nonadjuvant group). RESULTS Adjuvant and nonadjuvant therapy groups were not significantly different with respect to age, sex, performance status, tumor grade, and tumor location. Overall, 5 of the 16 patients (31%) in the adjuvant group and 4 of the 11 patients (36%) in the nonadjuvant group had recurrence of cancer at 40 months of follow-up. The two groups demonstrated no significant differences in recurrence-free survival (p = 0.794) and disease-specific survival (p = 0.783). CONCLUSIONS Although it would be difficult to draw any definite conclusions from the results of our investigations, our data suggest that adjuvant therapy with traditional conventional chemotherapeutic regimens alone may not be effective as previously anticipated in significantly improving survival rates for locally advanced, but lymph node negative, TCC of the upper urinary tract.
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Affiliation(s)
- Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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Thymidylate synthetase allelic imbalance in clear cell renal carcinoma. Cancer Chemother Pharmacol 2009; 64:1195-200. [PMID: 19306093 DOI: 10.1007/s00280-009-0986-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 03/06/2009] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the allelic status of the thymidylate synthetase (TYMS) gene, located at chromosome band 18p11.32, in renal cell carcinoma (RCC). TYMS is a key target of the 5-fluorouracil (5-FU)-based class of drugs, frequently considered in combination therapies in advanced RCC. TYMS variants, such as the TYMS polymorphic 5'-untranslated region variable number tandem repeat sequence (VNTR), are under investigation to guide 5-FU treatment. Yet, no information is available with regard to changes in TYMS allele frequencies in RCC malignances. METHODS Blood and matched tumor samples were collected from 41 histological proven clear cell RCC affected patients (30 males, 11 females.). TYMS VNTR genotype was first determined in blood to identify heterozygotes employing PCR techniques. To evaluate for allelic imbalance, fragment analysis was performed both in blood and matched tumor DNA of the heterozygote patients. Microsatellite analysis, employing the markers D18S59 and D18S476 mapping, respectively, at the TYMS locus (18p11.32) and 1.5 Mb downstream of the TYMS gene sequence (18p11.31), was performed to confirm TYMS allelic imbalance in tumors. RESULTS Germ-line TYMS VNTR distribution was: 2R/2R (19.5%), TYMS 2R/3R (36.6%) and TYMS 3R/3R (43.9%). Allelic imbalance for the TYMS tandem repeat region was detected in 26.6% of the heterozygote patients. Microsatellite analysis confirmed the allelic imbalance detected by TYMS VNTR analysis and revealed that the overall frequence of allelic imbalance of chromosome band 18p11.32 was 35%, while the overall allelic imbalance of chromosome band 18p11.31 was 28%. CONCLUSIONS By focusing on the TYMS polymorphic variants in renal cancer, we here provide evidence, to our knowledge, for the first time showing loss of 18p11.32 and 18p11.31 in renal cell carcinomas. As allelic imbalances involving TYMS locus may be an important variable affecting 5-FU responsiveness, this study may contribute to explain different responses of advanced RCC in combined chemotherapeutic regimens incorporating fluoropyridines.
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Adjuvant intraoperative electron radiotherapy and external beam radiotherapy for locally advanced transitional cell carcinoma of the ureter. Urol Oncol 2009; 27:14-20. [DOI: 10.1016/j.urolonc.2007.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 07/31/2007] [Accepted: 07/31/2007] [Indexed: 01/15/2023]
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Kidney and Ureter Cancers. Radiat Oncol 2008. [DOI: 10.1007/978-3-540-77385-6_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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50
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Soga N, Arima K, Sugimura Y. Adjuvant methotrexate, vinblastine, adriamycin, and cisplatin chemotherapy has potential to prevent recurrence of bladder tumors after surgical removal of upper urinary tract transitional cell carcinoma. Int J Urol 2008; 15:800-3. [DOI: 10.1111/j.1442-2042.2008.02114.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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