ADJUVANT CHEMOTHERAPY FOR UPPER UROTHELIAL CARCINOMA

J Urol. 2015 Mar 18. pii: S0022-5347(15)03374-1. doi: 10.1016/j.juro.2015.03.077. [Epub ahead of print]

The efficacy of postoperative adjuvant chemotherapy for patients with pT3N0M0 upper tract urothelial carcinoma.

Huang YC1, Chen MF2, Shi CS3, Shindel AW4, Huang CE5, Pang ST6, Chuang CK6, Chen CS7, Chang YH6, Lin WY7, Ho DR7, Chin CC8, Kuo YH8, Wu CF9.

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Abstract

PURPOSE: 

Nephroureterectomy with bladder cuff excision (NU) may not be sufficient as monotherapy for patients with pT3N0M0 upper tract urothelial carcinoma (UTUC). The efficacy of postoperative adjuvant chemotherapy in this setting remains controversial. We evaluated the efficacy of adjuvant chemotherapy for patients with pT3N0M0 UTUC in overall, cancer-specific and recurrence-free survival.

MATERIALS AND METHODS: 

We retrospectively reviewed records on 171 consecutive patients with pT3N0M0 UTUC treated with NU between 2004 and 2014 at two branches of the same institution. Postoperative adjuvant chemotherapy was gemcitabine/cisplatin or cisplatin/flurouracil/leucovorin. Overall, cancer-specific and recurrence-free survival rates were estimated using the Kaplan-Meier method. The values of prognostic factors were evaluated by Cox regression analysis.

RESULTS: 

Postoperative adjuvant chemotherapy was administered in 60 patients versus non-adjuvant therapy in 111 patients. The median follow-up period was 35.8 months. Between the adjuvant and non-adjuvant treatment groups, there were statistically significant differences in 5-year cancer-specific (80.5% vs 57.6%, p = 0.010) and recurrence-free (74.4% vs 52.9%, p = 0.026) survival rates. Although there was no statistically significant difference in overall survival (71.9% vs 49.0%, p = 0.072), there was a trend of better overall survival in the patients who received postoperative chemotherapy. In multivariable analysis, age (p = 0.018), tumor location (p = 0.003) and adjuvant chemotherapy (p = 0.001) were the predictors for cancer-specific survival.

CONCLUSIONS: 

Adjuvant chemotherapy improves cancer-specific and recurrence-free survival in patients with pT3N0M0 UUTUC after NU.