新辅助化疗对淋巴结阳性上尿路尿路上皮癌有治疗益处吗？一项多中心队列研究的结果。
Does neoadjuvant chemotherapy have therapeutic benefit for node-positive upper tract urothelial carcinoma? Results of a multi-center cohort study.
作者信息
Shigeta Keisuke, Matsumoto Kazuhiro, Ogihara Koichiro, Murakami Tetsushi, Anno Tadatsugu, Umeda Kota, Izawa Mizuki, Baba Yuto, Sanjo Tansei, Shojo Kazunori, Tanaka Nobuyuki, Takeda Toshikazu, Morita Shinya, Kosaka Takeo, Mizuno Ryuichi, Arita Yuki, Akita Hirotaka, Jinzaki Masahiro, Kikuchi Eiji, Oya Mototsugu
机构信息
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
出版信息
Urol Oncol. 2022 Mar;40(3):105.e19-105.e26. doi: 10.1016/j.urolonc.2021.07.029. Epub 2021 Aug 25.
OBJECTIVE
The indications of neoadjuvant chemotherapy (NAC) for lymph node-positive upper tract urothelial carcinoma (UTUC) have not been investigated regarding improved survival outcomes. Our specific aim was to compare the clinical outcomes of clinically node-positive UTUC patients who were treated by NAC followed by radical nephroureterectomy (RNU) or upfront RNU followed by adjuvant chemotherapy (AC).
MATERIALS AND METHODS
Among 966 UTUC patients, we identified 89 with clinical nodal involvement who received either NAC before RNU nor AC after upfront RNU. Cox proportional hazard models were employed to evaluate the impact of chemotherapy modality on the oncological outcomes.
RESULTS
Of the patient cohort, 36 (40.4%) received NAC followed by RNU, whereas 53 (59.6%) underwent RNU followed by AC. Multivariate analysis revealed that tumor size ≥3 cm, clinical T4, and gemcitabine and cisplatin regimen were independent risk factors for disease recurrence, whereas NAC followed by RNU was an independent factor for favorable RFS. Furthermore, regarding cancer-specific survival (CSS), NAC followed by RNU remained an independent factor for favorable CSS. According to Kaplan-Meier analysis, the 1-year and 2-year RFS were 67.9% and 47.0%, respectively, in the NAC+RNU group, which were significantly higher than those in the RNU+AC group (43.9% and 24.6%, respectively, P = 0.006). Moreover, the 1-year and 2-year CSS were 80.5% and 64.2%, respectively, in the NAC+RNU group, which were higher than those in the RNU+AC group (68.6% and 48.2%, respectively, P = 0.016).
CONCLUSION
For node-positive UTUC patients, NAC followed by RNU was more clinically beneficial than RNU followed by AC.
目的
关于新辅助化疗（NAC）对淋巴结阳性上尿路尿路上皮癌（UTUC）生存结局改善方面的适应证尚未得到研究。我们的具体目的是比较接受NAC后行根治性肾输尿管切除术（RNU）的临床淋巴结阳性UTUC患者与先行RNU再行辅助化疗（AC）的患者的临床结局。
材料与方法
在966例UTUC患者中，我们确定了89例有临床淋巴结受累的患者，他们要么在RNU前接受了NAC，要么在先行RNU后接受了AC。采用Cox比例风险模型评估化疗方式对肿瘤学结局的影响。
结果
在该患者队列中，36例（40.4%）接受了NAC后行RNU，而53例（59.6%）接受了RNU后行AC。多因素分析显示，肿瘤大小≥3 cm、临床T4以及吉西他滨和顺铂方案是疾病复发的独立危险因素，而NAC后行RNU是无复发生存期（RFS）良好的独立因素。此外，关于癌症特异性生存（CSS），NAC后行RNU仍然是CSS良好的独立因素。根据Kaplan-Meier分析，NAC+RNU组的1年和2年RFS分别为67.9%和47.0%，显著高于RNU+AC组（分别为43.9%和24.6%，P = 0.006）。此外，NAC+RNU组的1年和2年CSS分别为80.5%和64.2%，高于RNU+AC组（分别为68.6%和48.2%，P = 0.016）。
结论
对于淋巴结阳性的UTUC患者，NAC后行RNU在临床上比RNU后行AC更有益。
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