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The role of adjuvant chemotherapy for lymph node‐positive upper tract urothelial carcinoma following radical nephroureterectomy: a retrospective study
Author(s) -
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.,
Klatte Tobias
Publication year - 2015
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12801
Subject(s) - medicine , urology , lymph node , retrospective cohort study , urothelial carcinoma , lymph , population , adjuvant therapy , chemotherapy , oncology , cancer , bladder cancer , pathology , environmental health
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 ( LN s) 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 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 pT 3–4 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 pT 3–4 LN ‐positive UTUC after RNU . This subgroup of LN ‐positive patients could serve as target population for an AC prospective randomised trial.