BJU International, July 2015, Vol.116(1), pp.72-78
To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1111/bju.12801/abstract Byline: Ilaria Lucca, Wassim Kassouf, Anil Kapoor, Adrian Fairey, Ricardo A. Rendon, Jonathan I. Izawa, Peter C. Black, Harun Fajkovic, Christian Seitz, Mesut Remzi, Peter Nyirady, Morgan Roupret, Vitaly Margulis, Yair Lotan, Michela Martino, Sebastian L. Hofbauer, Pierre I. Karakiewicz, Alberto Briganti, Giacomo Novara, Shahrokh F. Shariat, Tobias Klatte Keywords: adjuvant chemotherapy; upper tract urothelial carcinoma; radical nephroureterectomy; survival; lymph node positive 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 (T.sub.all 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.
Adjuvant Chemotherapy ; Upper Tract Urothelial Carcinoma ; Radical Nephroureterectomy ; Survival ; Lymph Node Positive