Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Canada.
Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.
Ann Surg Oncol. 2024 Oct;31(10):7229-7236. doi: 10.1245/s10434-024-15814-8. Epub 2024 Jul 20.
The purpose of this study was to test for survival differences according to adjuvant chemotherapy (AC) status in radical nephroureterectomy (RNU) patients with pT2-T4 and/or N1-2 upper tract urothelial carcinoma (UTUC).
Within the Surveillance, Epidemiology, and End Results database (SEER, 2007-2020), patients with UTUC treated with AC versus RNU alone were identified. Kaplan-Meier plots and multivariable Cox regression models addressed cancer-specific mortality (CSM).
Of 1995 patients with UTUC, 804 (40%) underwent AC versus 1191 (60%) RNU alone. AC rates increased from 36.1 to 57.0% over time in the overall cohort [estimated annual percentage changes (EAPC) ± 4.5%, p < 0.001]. The increase was from 28.8 to 50.0% in TanyN0 patients (EAPC ± 7.8%, p < 0.001) versus 50.0-70.9% in TanyN1-2 patients (EAPC ± 2.3%, p = 0.002). Within 698 patients harboring TanyN1-2 stage, median CSM was 31 months after AC versus 16 months in RNU alone (Δ = 15 months, p < 0.0001) and AC independently predicted lower CSM [hazard ratio (HR) 0.64; p < 0.001]. Similarly, within subgroup analyses according to stage, relative to RNU alone, AC independently predicted lower CSM in T2N1-2 (HR 0.49; p = 0.04), in T3N1-2 (HR 0.72; p = 0.015), and in T4N1-2 (HR 0.49, p < 0.001) patients. Conversely, in all TanyN0 as well as in all stage-specific subgroup analyses addressing N0 patients, AC did not affect CSM rates (all p > 0.05).
In RNU patients, AC use is associated with significantly lower CSM in lymph-node-positive (N1-2) patients but not in lymph-node-negative patients (N0). The distinction between N1-2 and N0 regarding the effect of AC on CSM applied across all T stages from T2 to T4, inclusively.
本研究旨在检测接受根治性肾输尿管切除术（RNU）治疗且具有 pT2-T4 和/或 N1-2 上尿路上皮癌（UTUC）的患者中，辅助化疗（AC）状态对生存的影响。
本研究利用监测、流行病学和最终结果数据库（SEER，2007-2020 年），确定了接受 AC 联合 RNU 治疗与单纯 RNU 治疗的 UTUC 患者。通过 Kaplan-Meier 图和多变量 Cox 回归模型分析癌症特异性死亡率（CSM）。
在 1995 例 UTUC 患者中，804 例（40%）接受了 AC 联合 RNU 治疗，1191 例（60%）仅接受了 RNU 治疗。在整个队列中，AC 率从 36.1%增加到 57.0%[估计每年百分比变化（EAPC）±4.5%，p<0.001]。在 TanyN0 患者中，AC 率从 28.8%增加到 50.0%（EAPC±7.8%，p<0.001），而在 TanyN1-2 患者中，AC 率从 50.0%增加到 70.9%（EAPC±2.3%，p=0.002）。在 698 例 TanyN1-2 期患者中，AC 后中位 CSM 为 31 个月，而单纯 RNU 治疗为 16 个月（Δ=15 个月，p<0.0001），AC 独立预测 CSM 降低[风险比（HR）0.64；p<0.001]。同样，根据分期的亚组分析显示，与单纯 RNU 治疗相比，AC 独立预测 T2N1-2（HR 0.49；p=0.04）、T3N1-2（HR 0.72；p=0.015）和 T4N1-2（HR 0.49，p<0.001）患者的 CSM 降低。相反，在所有 TanyN0 以及所有 N0 患者的分期亚组分析中，AC 对 CSM 率没有影响（所有 p>0.05）。
在 RNU 患者中，AC 应用与淋巴结阳性（N1-2）患者的 CSM 显著降低相关，但与淋巴结阴性（N0）患者无关。AC 对 CSM 的影响在所有 T 分期（T2 至 T4）中从 N1-2 到 N0 都有区别。
