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The role of adjuvant chemotherapy for lymph node‐positive upper tract urothelial carcinoma following radical nephroureterectomy: a retrospective study

The role of adjuvant chemotherapy for lymph node‐positive upper tract urothelial carcinoma... 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 (Tall 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. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png BJU International Wiley

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References (41)

Publisher
Wiley
Copyright
BJUI © 2015 BJU International
ISSN
1464-4096
eISSN
1464-410X
DOI
10.1111/bju.12801
pmid
24825476
Publisher site
See Article on Publisher Site

Abstract

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 (Tall 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.

Journal

BJU InternationalWiley

Published: Jul 1, 2015

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