Efficacy of Preoperative Chemotherapy for High Risk Upper Tract Urothelial Carcinoma
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu časopisecké články, multicentrická studie, pozorovací studie
- Klíčová slova
- carcinoma, neoadjuvant therapy, nephroureterectomy, transitional cell,
- MeSH
- adjuvantní chemoterapie MeSH
- analýza přežití MeSH
- karcinom z přechodných buněk farmakoterapie mortalita patologie chirurgie MeSH
- lidé MeSH
- logistické modely MeSH
- nádory močového měchýře farmakoterapie mortalita patologie chirurgie MeSH
- následné studie MeSH
- nefrektomie * MeSH
- neoadjuvantní terapie * MeSH
- protinádorové látky terapeutické užití MeSH
- protokoly protinádorové kombinované chemoterapie terapeutické užití MeSH
- retrospektivní studie MeSH
- riziko MeSH
- rozvrh dávkování léků MeSH
- staging nádorů MeSH
- ureter chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- Názvy látek
- protinádorové látky MeSH
PURPOSE: The impact of preoperative chemotherapy in patients with upper urinary tract urothelial carcinoma remains poorly investigated. We assessed the rates of pathological complete response (pT0N0/X) and downstaging (pT1N0/X or less) at radical nephroureterectomy after preoperative chemotherapy and evaluated their impact on survival. MATERIALS AND METHODS: This was an international observational study of patients who underwent preoperative chemotherapy and radical nephroureterectomy for high risk upper tract urothelial carcinoma between 2005 and 2017. Multiple imputation of chained equations was applied to account for missing values. Logistic regression analyses were performed to identify predictors of pathological response. Cox proportional hazard regression models were used to estimate recurrence-free survival, cancer specific survival and overall survival. RESULTS: A total of 267 patients met our inclusion criteria. Among included patients 82 (31%) received methotrexate, vinblastine, doxorubicin and cisplatin; 123 (46%) gemcitabine and cisplatin; 25 (9%) gemcitabine and carboplatin; and 32 (12%) other regimens. The overall rates of pathological complete response and pathological downstaging were 10.1% and 44.9%, respectively. On multivariable analysis the use of gemcitabine and cisplatin, and gemcitabine and carboplatin was not statistically different from methotrexate, vinblastine, doxorubicin and cisplatin in achieving pathological complete response and pathological downstaging, respectively. The number of administered cycles did not appear to have an effect on pathological responses. Pathological downstaging was the strongest prognostic factor for recurrence-free survival (HR 0.2, p <0.001), cancer specific survival (HR 0.19, p <0.001) and overall survival (HR 0.40, p <0.001). CONCLUSIONS: Pathological downstaging after preoperative chemotherapy is a robust prognostic factor at radical nephroureterectomy and is associated with improved survival outcomes. Although preoperative chemotherapy appears to be effective, well designed prospective studies are still needed.
Department of Genitourinary Oncology Moffitt Cancer Center Tampa Florida
Department of Surgery Division of Urology McGill University Health Center Montreal Canada
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Urology Jikei University School of Medicine Tokyo Japan
Department of Urology Kantonsspital Winterthur Winterthur Switzerland
Department of Urology MD Anderson Cancer Center Houston Texas
Department of Urology Medical University of Vienna Vienna Austria
Department of Urology Ohio State University Columbus Ohio
Department of Urology Seoul National University Hospital Seoul Korea
Department of Urology University Hospitals Leuven Leuven Belgium
Department of Urology University of Texas Southwestern Medical Center Dallas Texas
Department of Urology Weill Cornell Medical College New York New York
Karl Landsteiner Institute of Urology and Andrology Vienna Austria
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