Hellenthal Nicholas J, Shariat Shahrokh F, Margulis Vitaly, Karakiewicz Pierre I, Roscigno Marco, Bolenz Christian, Remzi Mesut, Weizer Alon, Zigeuner Richard, Bensalah Karim, Ng Casey K, Raman Jay D, Kikuchi Eiji, Montorsi Francesco, Oya Mototsugu, Wood Christopher G, Fernandez Mario, Evans Christopher P, Koppie Theresa M
University of California-Davis, Sacramento, California 95817, USA.
J Urol. 2009 Sep;182(3):900-6. doi: 10.1016/j.juro.2009.05.011. Epub 2009 Jul 17.
There is relatively little literature on adjuvant chemotherapy after radical nephroureterectomy in patients with upper tract urothelial carcinoma. We determined the incidence of adjuvant chemotherapy in high risk patients and the ensuing effect on overall and cancer specific survival.
Using an international collaborative database we identified 1,390 patients who underwent nephroureterectomy for nonmetastatic upper tract urothelial carcinoma between 1992 and 2006. Of these cases 542 (39%) were classified as high risk (pT3N0, pT4N0 and/or lymph node positive). These patients were divided into 2 groups, including those who did and did not receive adjuvant chemotherapy, and stratified by gender, age group, performance status, and tumor grade and stage. Cox proportional hazard modeling and Kaplan-Meier analysis were used to determine overall and cancer specific survival in the cohorts.
Of high risk patients 121 (22%) received adjuvant chemotherapy. Adjuvant chemotherapy was more commonly administered in the context of increased tumor grade and stage (p <0.001). Median survival in the entire cohort was 24 months (range 0 to 231). There was no significant difference in overall or cancer specific survival between patients who did and did not receive adjuvant chemotherapy. However, age, performance status, and tumor grade and stage were significant predictors of overall and cancer specific survival.
Adjuvant chemotherapy is infrequently used to treat high risk upper tract urothelial carcinoma after nephroureterectomy. Despite this finding it appears that adjuvant chemotherapy confers minimal impact on overall or cancer specific survival in this group.
关于上尿路尿路上皮癌患者根治性肾输尿管切除术后辅助化疗的文献相对较少。我们确定了高危患者辅助化疗的发生率及其对总生存期和癌症特异性生存期的后续影响。
利用一个国际合作数据库，我们识别出1992年至2006年间因非转移性上尿路尿路上皮癌接受肾输尿管切除术的1390例患者。其中542例（39%）被归类为高危患者（pT3N0、pT4N0和/或淋巴结阳性）。这些患者被分为两组，包括接受和未接受辅助化疗的患者，并按性别、年龄组、体能状态以及肿瘤分级和分期进行分层。采用Cox比例风险模型和Kaplan-Meier分析来确定队列中的总生存期和癌症特异性生存期。
高危患者中有121例（22%）接受了辅助化疗。辅助化疗在肿瘤分级和分期增加的情况下更常使用（p<0.001）。整个队列的中位生存期为24个月（范围0至231个月）。接受和未接受辅助化疗的患者在总生存期或癌症特异性生存期方面没有显著差异。然而，年龄、体能状态以及肿瘤分级和分期是总生存期和癌症特异性生存期的重要预测因素。
辅助化疗很少用于治疗肾输尿管切除术后的高危上尿路尿路上皮癌。尽管有这一发现，但辅助化疗似乎对该组患者的总生存期或癌症特异性生存期影响极小。
