Does neoadjuvant chemotherapy have therapeutic benefit for node-positive upper tract urothelial carcinoma? Results of a multi-center cohort study
Does neoadjuvant chemotherapy have therapeutic benefit for node-positive upper tract urothelial carcinoma? Results of a multi-center cohort study
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DOI：
10.1016/j.urolonc.2021.07.029
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发表时间：
2022-02-24
影响因子：
2.7
通讯作者：
Oya, Mototsugu
中科院分区：
文献类型：
--
作者：
Shigeta, Keisuke;Matsumoto, Kazuhiro;Oya, Mototsugu
目的：尚未研究淋巴结阳性上尿路尿路上皮癌（UTUC）新辅助化疗（NAC）的适应症是否能改善生存结果。我们的具体目的是比较临床淋巴结阳性 UTUC 患者的临床结果，这些患者接受 NAC 后接受根治性肾输尿管切除术 (RNU) 或前期 RNU 后接受辅助化疗 (AC)。 材料和方法：在 966 名 UTUC 患者中，我们确定了 89 名临床淋巴结受累的患者，他们在 RNU 之前接受 NAC，在前期 RNU 后接受 AC。采用 Cox 比例风险模型来评估化疗方式对肿瘤学结果的影响。结果：在患者队列中，36 例 (40.4%) 接受 NAC，然后接受 RNU，而 53 例 (59.6%) 接受 RNU，然后接受 AC。多变量分析显示，肿瘤大小>= 3 cm、临床T4、吉西他滨和顺铂方案是疾病复发的独立危险因素，而NAC随后是RNU是良好RFS的独立危险因素。此外，关于癌症特异性生存（CSS），NAC 其次是 RNU 仍然是有利 CSS 的独立因素。根据Kaplan-Meier分析，NAC+RNU组的1年和2年RFS分别为67.9%和47.0%，显着高于RNU+AC组（分别为43.9%和24.6%，P=0.006）。 NAC+RNU组1年和2年CSS分别为80.5%和64.2%，高于RNU+AC组（分别为68.6%和48.2%，P=0.016）。结论：对于淋巴结阳性UTUC患者，NAC+RNU+AC比RNU+AC更有临床获益。 (C) 2021 Elsevier Inc. 保留所有权利。
Objective: The indications of neoadjuvant chemotherapy (NAC) for lymph node-positive upper tract urothelial carcinoma (UTUC) have not been investigated regarding improved survival outcomes. Our specific aim was to compare the clinical outcomes of clinically node-positive UTUC patients who were treated by NAC followed by radical nephroureterectomy (RNU) or upfront RNU followed by adjuvant chemotherapy (AC).Materials and methods: Among 966 UTUC patients, we identified 89 with clinical nodal involvement who received either NAC before RNU nor AC after upfront RNU. Cox proportional hazard models were employed to evaluate the impact of chemotherapy modality on the oncological outcomes.Results: Of the patient cohort, 36 (40.4%) received NAC followed by RNU, whereas 53 (59.6%) underwent RNU followed by AC. Multivariate analysis revealed that tumor size >= 3 cm, clinical T4, and gemcitabine and cisplatin regimen were independent risk factors for disease recurrence, whereas NAC followed by RNU was an independent factor for favorable RFS. Furthermore, regarding cancer-specific survival (CSS), NAC followed by RNU remained an independent factor for favorable CSS. According to Kaplan-Meier analysis, the 1-year and 2-year RFS were 67.9% and 47.0%, respectively, in the NAC+RNU group, which were significantly higher than those in the RNU+AC group (43.9% and 24.6%, respectively, P = 0.006). Moreover, the 1-year and 2-year CSS were 80.5% and 64.2%, respectively, in the NAC +RNU group, which were higher than those in the RNU+AC group (68.6% and 48.2%, respectively, P = 0.016).Conclusion: For node-positive UTUC patients, NAC followed by RNU was more clinically beneficial than RNU followed by AC. (C) 2021 Elsevier Inc. All rights reserved.