新辅助化疗两个周期可改善高危上尿路尿路上皮癌患者的生存。

Two cycles of neoadjuvant chemotherapy improves survival in patients with high-risk upper tract urothelial carcinoma.

机构信息

Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan.

Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan.

出版信息

BJU Int. 2021 Mar;127(3):332-339. doi: 10.1111/bju.15230. Epub 2020 Sep 28.

DOI:10.1111/bju.15230

PMID:32896105

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7984033/

Abstract

OBJECTIVES

To assess the impact of two cycles of neoadjuvant chemotherapy (NAC) in patients who underwent nephroureterectomy for high-risk cN0M0 upper tract urothelial carcinoma (UTUC), and to evaluate the efficacy of NAC in patients with localised disease (≤cT2).

PATIENTS AND METHODS

We retrospectively analysed patients with high-risk cN0M0 UTUC who received NAC followed by surgery, compared with a matched cohort who underwent initial surgery at Fujita Health University during 2005-2019. Baseline and tumour characteristics, overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were compared between the cohorts. Cox proportional hazards models were used to identify predictors of survival.

RESULTS

There were 117 and 67 patients in the study group and the control group, respectively. Significantly higher pathological downstaging (pDS) and lower lymphovascular invasion (LVI) were observed in the study group than in the control group (48% vs 22%, P = 0.008 and 29% vs 46%, P = 0.045, respectively). The NAC group had significantly better 5-year OS (79% vs 53%, P = 0.003), 5-year CSS (84% vs 66%, P = 0.008), and 5-year RFS (80% vs 61%, P = 0.001) than the control group. The OS benefit of NAC was observed even in patients with localised (≤cT2) disease (P = 0.019). Patients with LVI showed significantly worse CSS both in pathologically locally advanced (≥pT3) and in localised (≤pT2) tumours (P = 0.048 and P = 0.018, respectively). Multivariate analysis identified LVI, NAC, and pDS as independent predictors of OS. Male sex and post-NAC LVI were identified as predictors of worse survival in patients who underwent NAC.

CONCLUSIONS

Two cycles of NAC improved the survival of patients with high-risk UTUC, even in patients with localised disease. Although two cycles of NAC appear to be effective in cN0M0 high-risk UTUC including localised disease, additional larger sample size multicentre prospective studies comparing short-course NAC regimens followed by surgery and surgery alone are required.

摘要

目的

评估在接受肾输尿管切除术治疗高危 cN0M0 上尿路上皮癌（UTUC）的患者中进行两周期新辅助化疗（NAC）的影响，并评估 NAC 在局部疾病（≤cT2）患者中的疗效。

患者和方法

我们回顾性分析了在藤田保健大学于 2005-2019 年期间接受 NAC 后手术的高危 cN0M0 UTUC 患者，并与接受初始手术的匹配队列进行比较。比较两组患者的基线和肿瘤特征、总生存期（OS）、癌症特异性生存期（CSS）和无复发生存期（RFS）。使用 Cox 比例风险模型确定生存的预测因素。

结果

研究组和对照组分别有 117 例和 67 例患者。研究组病理降期（pDS）和淋巴血管侵犯（LVI）显著高于对照组（48%比 22%，P=0.008 和 29%比 46%，P=0.045）。NAC 组患者的 5 年 OS（79%比 53%，P=0.003）、5 年 CSS（84%比 66%，P=0.008）和 5 年 RFS（80%比 61%，P=0.001）显著优于对照组。即使在局部疾病（≤cT2）患者中，NAC 也能显著提高 OS（P=0.019）。在病理局部进展（≥pT3）和局部（≤pT2）肿瘤中，有 LVI 的患者 CSS 均显著更差（P=0.048 和 P=0.018）。多变量分析确定 LVI、NAC 和 pDS 是 OS 的独立预测因素。男性和 NAC 后 LVI 是接受 NAC 的患者生存较差的预测因素。