Chang Yi-Huei, Hsiao Po-Jen, Chen Guang-Heng, Lin Ching-Chan, Chang Chao-Hsiang, Wu Hsi-Chin, Huang Chi-Ping, Yang Chi-Rei, Yeh Su-Peng
Department of Urology, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan, R.O.C.
Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan, R.O.C.
Oncol Lett. 2019 Jan;17(1):1341-1348. doi: 10.3892/ol.2018.9672. Epub 2018 Nov 7.
The present retrospective study aimed to examine the outcomes of stage II-IV upper-tract urothelial carcinoma (UTUC) and determine whether adjuvant chemotherapy is a beneficial treatment for patients with locally advanced UTUC (specifically, stage III-IV). The analysis included 126 patients with muscle-invasive UTUC who were treated between June 2003 and June 2012. All patients underwent laparoscopic or open nephroureterectomy and bladder cuff excision. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS) and locoregional recurrence-free survival (LRFS) were assessed. Outcomes were compared between groups of patients with stage II (high-stage localized) disease, stage III-IV (high-stage locally advanced) disease treated with chemotherapy, and stage III-IV disease not treated with chemotherapy. Among patients with high-stage locally advanced UTUC (stage III-IV), those who received adjuvant chemotherapy had significantly better rates of OS (67.1 vs. 33.7%; P=0.004), DFS (70.2 vs. 46.0%; P=0.030) and DMFS (86.3 vs. 65.2%; P=0.048) at 5-years compared with those who did not undergo adjuvant chemotherapy. However, there was no significant difference between the 5-year LRFS rates in these two groups (78.2 vs. 62.5%; P=0.525). Importantly, the survival curve of patients with high-stage UTUC who received adjuvant chemotherapy was similar to that of patients with low-stage UTUC who underwent surgery only. Multivariate analysis revealed that adjuvant chemotherapy was an independent risk factor for OS [without adjuvant chemotherapy vs. with adjuvant chemotherapy: Hazard ratio (HR), 0.29; 95% confidence interval (CI), 0.129-0.654; P=0.003] and DFS (without adjuvant chemotherapy vs. with adjuvant chemotherapy: HR, 0.381; 95% CI, 0.168-0.865; P=0.021). In conclusion, adjuvant chemotherapy may improve the outcome for patients with high-stage locally advanced UTUC.
本回顾性研究旨在探讨Ⅱ-Ⅳ期上尿路尿路上皮癌（UTUC）的治疗结果，并确定辅助化疗对局部晚期UTUC患者（具体为Ⅲ-Ⅳ期）是否为有益的治疗方法。该分析纳入了2003年6月至2012年6月期间接受治疗的126例肌层浸润性UTUC患者。所有患者均接受了腹腔镜或开放性肾输尿管切除术及膀胱袖口切除术。评估了总生存期（OS）、无病生存期（DFS）、无远处转移生存期（DMFS）和无局部区域复发生存期（LRFS）。对Ⅱ期（高分期局限性）疾病患者、接受化疗的Ⅲ-Ⅳ期（高分期局部晚期）疾病患者和未接受化疗的Ⅲ-Ⅳ期疾病患者组的治疗结果进行了比较。在高分期局部晚期UTUC（Ⅲ-Ⅳ期）患者中，与未接受辅助化疗的患者相比，接受辅助化疗的患者5年时的OS率（67.1%对33.7%；P=0.004）、DFS率（70.2%对46.0%；P=0.030）和DMFS率（86.3%对65.2%；P=0.048）显著更高。然而，这两组患者的5年LRFS率之间无显著差异（78.2%对62.5%；P=0.525）。重要的是，接受辅助化疗的高分期UTUC患者的生存曲线与仅接受手术的低分期UTUC患者的生存曲线相似。多因素分析显示，辅助化疗是OS[未接受辅助化疗与接受辅助化疗：风险比（HR），0.29；95%置信区间（CI），0.129-0.654；P=0.003]和DFS（未接受辅助化疗与接受辅助化疗：HR，0.381；95%CI，0.168-0.865；P=0.021）的独立危险因素。总之，辅助化疗可能改善高分期局部晚期UTUC患者的治疗结果。
