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- Title
The role of adjuvant chemotherapy for lymph node-positive upper tract urothelial carcinoma following radical nephroureterectomy: a retrospective study.
- Authors
Lucca, Ilaria; Kassouf, Wassim; Kapoor, Anil; Fairey, Adrian; Rendon, Ricardo A.; Izawa, Jonathan I.; Black, Peter C.; Fajkovic, Harun; Seitz, Christian; Remzi, Mesut; Nyirády, Peter; Rouprêt, Morgan; Margulis, Vitaly; Lotan, Yair; Martino, Michela; Hofbauer, Sebastian L.; Karakiewicz, Pierre I.; Briganti, Alberto; Novara, Giacomo; Shariat, Shahrokh F.
- Abstract
Objective To evaluate the effect of adjuvant chemotherapy ( AC) on mortality after radical nephroureterectomy ( RNU) for upper tract urothelial carcinoma ( UTUC) with positive lymph nodes ( LNs) and to identify patient subgroups that are most likely to benefit from AC. Patients and methods We retrospectively analysed data of 263 patients with LN-positive UTUC, who underwent full surgical resection. In all, 107 patients (41%) received three to six cycles of AC, while 156 (59.3%) were treated with RNU alone. UTUC-related mortality was evaluated using competing-risks regression models. Results In all patients (Tall N+), administration of AC had no significant impact on UTUC-related mortality on univariable ( P = 0.49) and multivariable ( P = 0.11) analysis. Further stratified analyses showed that only N+ patients with pT3-4 disease benefited from AC. In this subgroup, AC reduced UTUC-related mortality by 34% ( P = 0.019). The absolute difference in mortality was 10% after the first year and increased to 23% after 5 years. On multivariable analysis, administration of AC was associated with significantly reduced UTUC-related mortality (subhazard ratio 0.67, P = 0.022). Limitations of this study are the retrospective non-randomised design, selection bias, absence of a central pathological review and different AC protocols. Conclusions AC seems to reduce mortality in patients with pT3-4 LN-positive UTUC after RNU. This subgroup of LN-positive patients could serve as target population for an AC prospective randomised trial.
- Subjects
CANCER chemotherapy; LYMPH node cancer; CANCER-related mortality; TRANSITIONAL cell carcinoma; SURGICAL excision; RETROSPECTIVE studies; CANCER treatment
- Publication
BJU International, 2015, Vol 116, Issue 1, p72
- ISSN
1464-4096
- Publication type
Article
- DOI
10.1111/bju.12801