Adjuvant chemotherapy improves overall survival in patients with localized upper tract urothelial carcinoma harboring pathologic vascular invasion: a propensity score-matched analysis of multi-institutional cohort
Adjuvant chemotherapy improves overall survival in patients with localized upper tract urothelial carcinoma harboring pathologic vascular invasion: a propensity score-matched analysis of multi-institutional cohort
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DOI：
10.1007/s00345-020-03118-x
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发表时间：
2020-02-17
影响因子：
3.4
通讯作者：
Azuma, Haruhito
中科院分区：
文献类型：
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作者：
Matsunaga, Tomohisa;Komura, Kazumasa;Azuma, Haruhito
目的上尿路上皮癌(UTUC)的辅助化疗(AC)是否有利于患者的生存仍存在争议。为了探讨AC对cN0M0 UTUC患者总生存期(OS)的影响，我们使用回归模型进行了倾向分数匹配分析，包括淋巴管和血管侵犯等病理特征。方法采用多机构队列研究，共收集UTUC患者病历413份。结果98例患者中，根治性肾输尿管切除术(RNU)患者49例(RNU组49例，RNU+AC组49例)符合配对标准。Kaplan-Meier曲线显示，复发组患者的5年OS率为72.7%，显著高于复发组的51.6%(p=0.0156)。多因素分析显示，病理性血管侵犯(HR3.41，95%CI1.24~10.66，p=0.0166)和使用AC(HR0.45，95%CI0.19~0.98，p=0.0438)仍是OS的显著预测因素。在有病理性血管侵犯的患者(51例)中，RNU+AC组的OS显著延长(RNU组和RNU+AC组的中位OS分别为30个月和70个月：P=0.0432)，而在无血管侵犯的患者中，RNU组(中位OS：未达到)和RNU+AC组(中位OS：未达到)的OS无显著差异(P=0.4549)。结论AC对OS有明显的治疗作用，RNU标本中的病理性血管侵犯可帮助患者更好地预测AC的疗效。
Objective Whether adjuvant chemotherapy (AC) for patients with upper tract urothelial carcinoma (UTUC) offers survival benefit is still controversial. To explore the impact of AC on overall survival (OS) of cN0M0 UTUC patients, we conducted a propensity score-matched analysis using the regression model, including pathologic features such as lymphatic and vascular invasion. Methods A multi-institutional cohort of 413 UTUC patient record was used. Propensity score matching was performed to reduce bias by potential confounding factors for survival, including pathologic features from the specimen of radical nephroureterectomy (RNU), Results Ninety-eight patients were identified as pair-matched groups (49 patients in RNU and 49 patients in RNU + AC). Kaplan-Meier curves demonstrated that a 5-year OS rate of 72.7% for patients treated with RNU + AC was significantly higher than 51.6% for those treated with RNU (p = 0.0156). On multivariate analysis, pathologic vascular invasion (HR 3.41, 95% CI 1.24-10.66, p = 0.0166) and administration of AC (HR 0.45, 95% CI 0.19-0.98, p = 0.0438) still remained as the significant predictors for OS. In patients with pathologic vascular invasion (51 of 98 patients), a significantly longer OS in RNU + AC groups was observed (median OS of 30 and 70 months in RNU and RNU + AC groups, respectively: p = 0.0432), whereas there was no significant difference in the OS between RNU (median OS: not reached) and RNU + AC (median OS: not reached) groups in patients without the invasion (p = 0.4549). Conclusion The result indicates a significant benefit for OS by the administration of AC, and pathologic vascular invasion in the specimen of RNU could help the patient selection to better predict the effect of AC.