Role of adjuvant chemotherapy for lymph node-positive upper tract urothelial carcinoma and the prognostic significance of C-reactive protein: A multi-institutional, retrospective study.

OBJECTIVE

To analyze the role of adjuvant chemotherapy in lymph node-positive patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy, and identified the prognostic adjuvant chemotherapy parameters.

METHODS

The clinicopathological records of 74 lymph node-positive upper tract urothelial carcinoma patients who underwent radical nephroureterectomy at multiple institutions were retrospectively reviewed. A total of 45 patients (60.8%) received adjuvant chemotherapy, and 29 (39.2%) underwent radical nephroureterectomy only. Kaplan-Meier analyses and Cox proportional hazard modeling were used to study the association between adjuvant chemotherapy status and both recurrence-free survival and cancer-specific survival.

RESULTS

Estimated 5-year recurrence-free survival was 33.6% in patients undergoing radical nephroureterectomy plus adjuvant chemotherapy compared with 13.5% in patients undergoing radical nephroureterectomy only (hazard ratio 0.52; P = 0.014, log-rank test). Estimated 5-year cancer-specific survival was 42.5% in patients undergoing radical nephroureterectomy plus adjuvant chemotherapy, compared with 12.0% in patients undergoing radical nephroureterectomy only (hazard ratio 0.36; P = 0.0003, log-rank test). Multivariate analysis showed that adjuvant chemotherapy was a significant prognostic factor for cancer-specific survival (P = 0.001), but not for recurrence-free survival (P = 0.076). When patients undergoing radical nephroureterectomy plus adjuvant chemotherapy were dichotomized, based on preoperative C-reactive protein levels above or below the normal value, higher C-reactive protein levels were significantly associated with poor survival (P = 0.012).

CONCLUSION

Adjuvant chemotherapy seems to improve cancer-specific survival in lymph node-positive patients with upper tract urothelial carcinoma. Preoperative C-reactive protein levels could carry a prognostic value in this setting, and lymph node-positive patients with low preoperative CRP values should be considered for adjuvant chemotherapy. Further studies are necessary to validate these observations.