Lo Chi-Wen, Li Wei-Ming, Ke Hung-Lung, Chang Yi-Huei, Wu Hsi-Chin, Chen I-Hsuan Alan, Lin Jen-Tai, Huang Chao-Yuan, Chen Chung-Hsin, Tseng Jen-Shu, Lin Wun-Rong, Jiang Yuan-Hong, Lee Yu-Khun, Tsai Chung-You, Chung Shiu-Dong, Hsueh Thomas Y, Chiu Allen W, Jou Yeong-Chin, Cheong Ian-Seng, Chen Yung-Tai, Chen Jih-Sheng, Chiang Bing-Juin, Yu Chih-Chin, Lin Wei Yu, Wu Chia-Chang, Chen Chuan-Shu, Weng Han-Yu, Tsai Yao-Chou
Division of Urology, Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
Front Oncol. 2022 Apr 22;12:843715. doi: 10.3389/fonc.2022.843715. eCollection 2022.
The advantage of adjuvant chemotherapy for upper urinary tract urothelial cancer (UTUC) has been reported, whereas its impact on upper tract cancer with variant histology remains unclear. We aimed to answer the abovementioned question with our real-world data.
Patients who underwent radical nephroureterectomy (RNU) and were confirmed to have variant UTUC were retrospectively evaluated for eligibility of analysis. In the Taiwan UTUC Collaboration database, we identified 245 patients with variant UTUC among 3,109 patients with UTUC who underwent RNU after excluding patients with missing clinicopathological information.
Those patients with variant UTUC were grouped based on their history of receiving adjuvant chemotherapy or not.
Propensity score matching was used to reduce the treatment assignment bias. Multivariable Cox regression model was used for the analysis of overall, cancer-specific, and disease-free survival.
For the patients with variant UTUC who underwent adjuvant chemotherapy compared with those without chemotherapy, survival benefit was identified in overall survival in univariate analysis (hazard ratio (HR), 0.527; 95% confidence interval (CI), 0.285-0.973; = 0.041). In addition, in multivariate analysis, patients with adjuvant chemotherapy demonstrated significant survival benefits in cancer-specific survival (OS; HR, 0.454; CI, 0.208-0.988; = 0.047), and disease-free survival (DFS; HR, 0.324; 95% CI, 0.155-0.677; ( = 0.003). The main limitations of the current study were its retrospective design and limited case number.
Adjuvant chemotherapy following RNU significantly improved cancer-related survivals in patients with UTUC with variant histology.
辅助化疗对上尿路尿路上皮癌（UTUC）的益处已有报道，但其对具有变异组织学的上尿路癌的影响仍不明确。我们旨在用真实世界数据回答上述问题。
设计、设置与参与者：对接受根治性肾输尿管切除术（RNU）且确诊为变异型UTUC的患者进行回顾性评估以确定分析的 eligibility。在台湾UTUC协作数据库中，我们在排除临床病理信息缺失的患者后，从3109例接受RNU的UTUC患者中识别出245例变异型UTUC患者。
那些变异型UTUC患者根据其是否接受辅助化疗的病史进行分组。
采用倾向评分匹配来减少治疗分配偏倚。多变量Cox回归模型用于分析总生存期、癌症特异性生存期和无病生存期。
对于接受辅助化疗的变异型UTUC患者与未接受化疗的患者相比，单因素分析中总生存期有生存获益（风险比（HR），0.527；95%置信区间（CI），0.285 - 0.973；P = 0.041）。此外，在多因素分析中，接受辅助化疗的患者在癌症特异性生存期（OS；HR，0.454；CI，0.208 - 0.988；P = 0.047）和无病生存期（DFS；HR，0.324；95% CI，0.155 - 0.677；P = 0.003）方面有显著的生存获益。本研究的主要局限性在于其回顾性设计和病例数有限。
RNU后辅助化疗显著改善了具有变异组织学的UTUC患者的癌症相关生存期。
