Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Urology, The Fraternity Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan.
World J Urol. 2017 Oct;35(10):1569-1575. doi: 10.1007/s00345-017-2032-6. Epub 2017 Apr 10.
To evaluate the efficacy of adjuvant systemic chemotherapy for locally advanced (pT3-4pN0/xM0) upper tract urothelial carcinoma (UTUC).
We retrospectively reviewed the medical records of 109 patients with pT3-4pN0/xM0 UTUC who had undergone radical nephroureterectomy between 1996 and 2013 at our four institutions. The patients were divided into two groups: those who received adjuvant chemotherapy (AC group) and those who did not (surgery-alone: SA group). All chemotherapy regimens were cisplatin-based. Cox proportional hazards regression models addressed the associations between clinicopathological factors and recurrence-free survival (RFS) and cancer-specific survival (CSS).
Forty-three (39.5%) out of the 109 patients underwent one to four cycles of adjuvant chemotherapy after nephroureterectomy. Median follow-up was 46.5 months. There were no significant differences in the background characteristics of the two groups, except for age. Recurrence developed in 11 (25.6%) and 29 (43.9%) patients in the AC and SA groups, respectively. Ultimately, six (14.0%) and 18 (27.3%) patients in the AC and SA groups, respectively, died of disease progression. On univariate analysis, hydronephrosis, nuclear grade, lymphovascular invasion, and adjuvant chemotherapy were significantly associated with both RFS and CSS. Charlson comorbidity index was associated only with CSS. On multivariate analysis, adjuvant chemotherapy was the only independent factor associated with improved RFS (p = 0.0178, HR = 0.41). Moreover, adjuvant chemotherapy (p = 0.0375, HR = 0.33), lower nuclear grade (p = 0.0070), and the absence of hydronephrosis (p = 0.0493) were independently associated with better CSS.
Locally advanced (pT3-4pN0/xM0) UTUC patients who underwent cisplatin-based adjuvant chemotherapy demonstrated better RFS and CSS than those without adjuvant chemotherapy.
评估局部晚期（pT3-4pN0/xM0）上尿路上皮癌（UTUC）辅助全身化疗的疗效。
我们回顾性分析了 1996 年至 2013 年在我们四个机构接受根治性肾输尿管切除术的 109 例 pT3-4pN0/xM0 UTUC 患者的病历。患者分为两组：接受辅助化疗（AC 组）和未接受化疗（单纯手术：SA 组）。所有化疗方案均基于顺铂。Cox 比例风险回归模型探讨了临床病理因素与无复发生存（RFS）和癌症特异性生存（CSS）之间的关系。
109 例患者中，43 例（39.5%）在肾输尿管切除术后接受了 1 至 4 个周期的辅助化疗。中位随访时间为 46.5 个月。两组患者的背景特征除年龄外无显著差异。AC 组和 SA 组分别有 11 例（25.6%）和 29 例（43.9%）患者复发。最终，AC 组和 SA 组分别有 6 例（14.0%）和 18 例（27.3%）患者死于疾病进展。单因素分析显示，肾盂积水、核分级、脉管侵犯和辅助化疗与 RFS 和 CSS 均显著相关。Charlson 合并症指数仅与 CSS 相关。多因素分析显示，辅助化疗是唯一与 RFS 改善相关的独立因素（p=0.0178，HR=0.41）。此外，辅助化疗（p=0.0375，HR=0.33）、较低的核分级（p=0.0070）和无肾盂积水（p=0.0493）与更好的 CSS 独立相关。
接受顺铂为基础的辅助化疗的局部晚期（pT3-4pN0/xM0）UTUC 患者的 RFS 和 CSS 优于未接受辅助化疗的患者。
