Incidence of downstaging and complete remission after neoadjuvant chemotherapy for high‐risk upper tract transitional cell carcinoma
Open Access
- 7 April 2010
- Vol. 116 (13), 3127-3134
- https://doi.org/10.1002/cncr.25050
Abstract
BACKGROUND: The authors evaluated the incidence of pathologic downstaging and complete remission (CR) in patients with high‐grade ureteral and renal pelvic transitional cell carcinoma (TCC) (upper tract TCC) who received neoadjuvant chemotherapy followed by surgery. METHODS: The study group comprised patients with biopsy‐demonstrated, high‐grade disease who received neoadjuvant chemotherapy followed by nephrouterectomy from 2004 to 2008, during which time patients uniformly were considered for neoadjuvant chemotherapy. The control group comprised patients with biopsy‐demonstrated, high‐grade disease who underwent initial nephroureterectomy from 1993 to 2004, when patients uniformly underwent initial surgery. Multiple clinical and pathologic features were evaluated, and the primary endpoint was pathologic tumor classification. RESULTS: One hundred seven patients in the control group underwent initial surgery, and 43 patients in the study group received neoadjuvant chemotherapy. Baseline demographics were similar between the groups except for a higher rate of sessile tumor architecture in the study group (72.1% vs 49.5%; P = .018). There was significant downstaging in study group patients compared with the historic control group (P = .004). The incidence of tumors classified as pathologic T2 (pT2) or as pT3 or higher was significantly lower in the study group (pT2, 65.4% vs 48.8%; P = .043; pT3 or higher, 47.7% vs 27.9%; P = .029). Fourteen percent of patients who received neoadjuvant chemotherapy had a pathologic CR. CONCLUSIONS: Neoadjuvant chemotherapy was associated with a 14% CR rate and a significant rate of downstaging. While longer follow‐up is awaited for survival data to mature, the current data provide justification for the sustained support of trials using this strategy. Cancer 2010. © 2010 American Cancer Society.Keywords
This publication has 25 references indexed in Scilit:
- Comparing Lymphadenectomy During Radical Nephroureterectomy: Open Versus LaparoscopicUrology, 2008
- Retroperitoneal Lymph Node Dissection (RPLD) in Conjunction with Nephroureterectomy in the Treatment of Infiltrative Transitional Cell Carcinoma (TCC) of the Upper Urinary Tract: Impact on SurvivalEuropean Urology, 2007
- Ability of Clinical Grade to Predict Final Pathologic Stage in Upper Urinary Tract Transitional Cell Carcinoma: Implications for TherapyUrology, 2007
- Transitional Cell Carcinoma of the Ureter: Prognostic Factors Influencing Progression and SurvivalEuropean Urology, 2007
- Nephroureterectomy for treating upper urinary tract transitional cell carcinoma: time to change the treatment paradigm?BJU International, 2006
- Importance of node dissection in relation to neoadjuvant and adjuvant therapy.Journal of the National Comprehensive Cancer Network, 2006
- Prognostic factors in urothelial renal pelvis and ureter tumours: a multicentre Rare Cancer Network studyEuropean Journal of Cancer, 1999
- Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patientsUrology, 1998
- Diagnostic Accuracy of Ureteroscopic Biopsy in Upper Tract Transitional Cell CarcinomaJournal of Urology, 1997
- Neoadjuvant Chemotherapy for Locally Advanced Urothelial Cancer of the Upper Urinary TractUrologia Internationalis, 1995