UT Southwestern Medical Center, Dallas, TX, USA.
BJU Int. 2011 Oct;108(8):1286-91. doi: 10.1111/j.1464-410X.2011.10075.x. Epub 2011 Feb 18.
• To describe a multicentre experience with preoperative platinum-based chemotherapy before radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC) with loco-regional nodal metastases.
• We identified 313 patients from the UTUC Collaboration (over 1200 patients), who underwent RNU with concomitant retroperitoneal lymph node dissection between 1990 and 2007 and met the inclusion criteria for one of three groups. • Group 1 comprised patients who received chemotherapy before RNU because of biopsy-proven loco-regional nodal metastases. • Group 2 consisted of patients who underwent primary RNU and were found to have metastatic nodal disease on final pathological review (node-positive). • Group 3 comprised a comparative cohort of patients treated with primary RNU for invasive or locally advanced (pT2/pT4) node-negative (N0) UTUC.
• Groups 1, 2 and 3 included 18, 120 and 175 patients, respectively. The 5-year disease-free survival rates were 49%, 30% and 64%, whereas the 5-year cancer-specific survival rates were 44%, 36% and 69% in groups 1, 2 and 3, respectively. • In group 1, on final pathological evaluation, nine patients were pN0, six patients were pT0 and five patients had pT0N0 disease. Kaplan-Meier survival analyses showed similar recurrence and survival rates in group 1 compared with group 3 (P= 0.14 and P= 0.06, respectively). • Meanwhile, group 2 had significantly lower disease-free and cancer-specific survival rates compared with group 3 (P < 0.001 and P < 0.001, respectively) and compared with group 1 (P= 0.04 and P= 0.06, respectively).
• Preoperative chemotherapy followed by aggressive surgical consolidation may yield favourable oncological outcomes in patients with UTUC with loco-regional nodal metastases. • These data support further evaluation of neoadjuvant systemic therapy in patients at risk for locally advanced UTUC.
描述在根治性肾输尿管切除术（RNU）前接受术前铂类为基础的化疗的多中心经验，这些患者患有上尿路上皮癌（UTUC）伴局部区域淋巴结转移。
我们从 UTUC 协作组中确定了 313 名患者（超过 1200 名患者），这些患者在 1990 年至 2007 年间接受了 RNU 手术，并伴有腹膜后淋巴结清扫术，并且符合以下三个组之一的纳入标准。组 1 包括因活检证实的局部区域淋巴结转移而在 RNU 前接受化疗的患者。组 2 由接受原发性 RNU 治疗且最终病理检查发现淋巴结转移的患者组成（淋巴结阳性）。组 3 包括一组接受原发性 RNU 治疗的侵袭性或局部晚期（pT2/pT4）淋巴结阴性（N0）UTUC 的患者。
组 1、2 和 3 分别包括 18、120 和 175 名患者。5 年无病生存率分别为 49%、30%和 64%，而 5 年癌症特异性生存率分别为 44%、36%和 69%。在组 1 中，在最终的病理评估中，9 名患者为 pN0，6 名患者为 pT0，5 名患者为 pT0N0 疾病。Kaplan-Meier 生存分析显示，组 1 与组 3 的复发和生存率相似（P=0.14 和 P=0.06）。同时，与组 3 相比，组 2 的无病生存率和癌症特异性生存率显著降低（P<0.001 和 P<0.001），与组 1 相比，组 2 的无病生存率和癌症特异性生存率也显著降低（P=0.04 和 P=0.06）。
术前化疗加积极的手术巩固治疗可能为局部区域淋巴结转移的 UTUC 患者带来良好的肿瘤学结果。这些数据支持进一步评估新辅助全身治疗在高危局部晚期 UTUC 患者中的作用。
