Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Urol. 2018 Jul;200(1):68-73. doi: 10.1016/j.juro.2017.12.054. Epub 2018 Jan 4.
High risk upper tract urothelial carcinoma has been associated with poor survival outcomes. Limited retrospective data support neoadjuvant chemotherapy prior to radical nephroureterectomy. To validate prior findings we evaluated differences in the pathological stage distribution in patients with high risk upper tract urothelial carcinoma based on the administration of neoadjuvant chemotherapy before radical nephroureterectomy.
We retrospectively analyzed the records of 240 patients with upper tract urothelial carcinoma at The Johns Hopkins Hospital from 2003 to 2017. Patients with biopsy proven high grade disease and a visible lesion on cross-sectional imaging were offered neoadjuvant chemotherapy prior to radical nephroureterectomy. A control group of a time matched cohort of patients with biopsy proven high grade disease underwent extirpative surgery alone. The chi-square and Fisher exact tests were used to evaluate clinical and pathological variables between the cohorts.
There were 32 patients in the study group and 208 in the control group. Significantly lower pathological stage was noted in the study group than in the control group (p <0.001). Significantly fewer patients with pT2 disease or higher were treated with neoadjuvant chemotherapy (37.5% vs 59.6%, p = 0.02). There was a 46.5% reduction in the prevalence of pT3 disease or higher in study group patients without clinically node positive or low volume metastatic disease (25.9% vs 48.4%, p = 0.04). A 9.4% complete remission rate was observed in patients who underwent neoadjuvant chemotherapy.
Patients with high risk upper tract urothelial carcinoma treated with neoadjuvant chemotherapy were noted to have a lower pathological stage distribution than patients treated with radical nephroureterectomy alone.
高危上尿路尿路上皮癌与不良生存结局相关。有限的回顾性数据支持在根治性肾输尿管切除术前进行新辅助化疗。为了验证先前的发现，我们评估了根据根治性肾输尿管切除术前新辅助化疗的应用，高危上尿路尿路上皮癌患者的病理分期分布差异。
我们回顾性分析了 2003 年至 2017 年约翰霍普金斯医院 240 例上尿路尿路上皮癌患者的记录。对经活检证实为高级别疾病且横断面成像可见病变的患者，在根治性肾输尿管切除术前提供新辅助化疗。一组与活检证实为高级别疾病的时间匹配队列的对照组仅接受根治性手术。使用卡方检验和 Fisher 精确检验评估两组之间的临床和病理变量。
研究组有 32 例患者，对照组有 208 例患者。研究组的病理分期明显低于对照组（p<0.001）。接受新辅助化疗的 pT2 期或更高分期的患者明显较少（37.5%比 59.6%，p=0.02）。在没有临床淋巴结阳性或低体积转移疾病的研究组患者中，pT3 期或更高分期的患病率降低了 46.5%（25.9%比 48.4%，p=0.04）。接受新辅助化疗的患者中有 9.4%观察到完全缓解率。
与单独接受根治性肾输尿管切除术治疗的患者相比，接受新辅助化疗的高危上尿路尿路上皮癌患者的病理分期分布较低。
