Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, 06973, Seoul, Republic of Korea.
Department of Urology, Hyundae General Hospital, Chung-Ang University College of Medicine, Gyeonggi-do, Republic of Korea.
BMC Urol. 2022 Nov 9;22(1):175. doi: 10.1186/s12894-022-01112-6.
This study aimed to evaluate the trend of adjuvant chemotherapy (AC) and neoadjuvant chemotherapy (NAC) in patients who underwent radical nephroureterectomy with bladder cuff excision (NUx) for upper tract urothelial carcinoma (UTUC) to compare the perioperative outcomes and overall survival (OS) between AC and NAC using nationwide population-based data.
We collected data on patients diagnosed with UTUC and treated with NUx between 2004 and 2016 using the National Health Insurance Service database, and evaluated the overall treatment trends. The AC and NAC groups were propensity score-matched. Cox proportional hazard and Kaplan-Meier analyses were used to assess survival.
Of the 8,705 enrolled patients, 6,627 underwent NUx only, 94 underwent NAC, and 1,984 underwent AC. The rate of NUx without perioperative chemotherapy increased from 70.8 to 78.2% (R = 0.632; p < 0.001). The rates of dialysis (p = 0.398), TUR-BT (p = 1.000), and radiotherapy (p = 0.497) after NUx were similar. In the Kaplan-Meier curve, the NAC and AC groups showed no significant difference (p = 0.480). In multivariate analysis, treatment with AC or NAC was not associated with OS (hazard ratio 0.83, 95% confidence interval 0.49-1.40, p = 0.477).
The use of NUx without perioperative chemotherapy has tended to increase in South Korea. Dialysis, TUR-BT, and radiotherapy rates after NUx were similar between the NAC and AC groups. There was no significant difference in OS between the NAC and AC groups. Proper perioperative chemotherapy according to patient and tumor conditions should be determined by obtaining more evidence of UTUC.
本研究旨在评估接受根治性肾输尿管切除术和膀胱袖状切除术（NUx）治疗上尿路上皮癌（UTUC）患者接受辅助化疗（AC）和新辅助化疗（NAC）的趋势，使用全国基于人群的数据比较 AC 和 NAC 之间的围手术期结局和总生存期（OS）。
我们使用国家健康保险服务数据库收集了 2004 年至 2016 年间诊断为 UTUC 并接受 NUx 治疗的患者的数据，并评估了整体治疗趋势。对 AC 和 NAC 组进行倾向评分匹配。使用 Cox 比例风险和 Kaplan-Meier 分析评估生存情况。
在纳入的 8705 例患者中，6627 例仅接受 NUx，94 例接受 NAC，1984 例接受 AC。无围手术期化疗的 NUx 率从 70.8%增加到 78.2%（R=0.632；p<0.001）。NUx 后透析（p=0.398）、TUR-BT（p=1.000）和放疗（p=0.497）的发生率相似。在 Kaplan-Meier 曲线中，NAC 和 AC 组之间无显著差异（p=0.480）。多变量分析显示，AC 或 NAC 治疗与 OS 无关（风险比 0.83，95%置信区间 0.49-1.40，p=0.477）。
在韩国，无围手术期化疗的 NUx 使用率呈上升趋势。NAC 和 AC 组 NUx 后透析、TUR-BT 和放疗的发生率相似。NAC 和 AC 组之间 OS 无显著差异。应根据患者和肿瘤情况确定适当的围手术期化疗，并通过获得更多 UTUC 的证据来确定。
