Adjuvant Chemotherapy for High Risk Upper Tract Urothelial Carcinoma: Results From the Upper Tract Urothelial Carcinoma Collaboration
- 17 July 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 182 (3), 900-906
- https://doi.org/10.1016/j.juro.2009.05.011
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.Keywords
This publication has 19 references indexed in Scilit:
- Lymphovascular Invasion and Pathologic Tumor Stage Are Significant Outcome Predictors for Patients With Upper Tract Urothelial CarcinomaUrology, 2008
- Management of patients with upper urinary tract transitional cell carcinomaNature Reviews Endocrinology, 2007
- Adjuvant Cisplatin Plus Methotrexate Versus Methotrexate, Vinblastine, Epirubicin, and Cisplatin in Locally Advanced Bladder Cancer: Results of a Randomized, Multicenter, Phase III Trial (AUO-AB 05/95)Journal of Clinical Oncology, 2005
- Neoadjuvant Chemotherapy plus Cystectomy Compared with Cystectomy Alone for Locally Advanced Bladder CancerNew England Journal of Medicine, 2003
- Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patientsUrology, 1998
- Neoadjuvant Chemotherapy for Locally Advanced Urothelial Cancer of the Upper Urinary TractUrologia Internationalis, 1995
- Tumors of the Upper Urinary Tract: 10 Years of ExperienceJournal of Urology, 1991
- Methotrexate, vinblastine, doxorubicin, and cisplatin for advanced transitional cell carcinoma of the urothelium. Efficacy and patterns of response and relapseCancer, 1989
- M-Vac (Methotrexate, Vinblastine, Doxorubicin and Cisplatin) Chemotherapy for Transitional Cell Carcinoma: The Princess Margaret Hospital ExperienceJournal of Urology, 1989
- Tumor grade and stage as prognostic variables in upper tract urothelial tumorsCancer, 1988