Yumioka Tetsuya, Morizane Shuichi, Muraoka Kuniyasu, Oono Hirofumi, Isoyama Tadahiro, Sakaridani Naoyuki, Ono Koji, Sejima Takehiro, Kadowaki Hiroyuki, Hikita Katsuya, Honda Masashi, Takenaka Atsushi
Department of Urology, Matsue Red Cross Hospital, Matsue 690-8506, Japan.
Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan.
Yonago Acta Med. 2024 Jul 10;67(3):183-190. doi: 10.33160/yam.2024.08.001. eCollection 2024 Aug.
Upper urinary tract urothelial carcinoma (UTUC) is uncommon. In advanced cases, radical nephroureterectomy (RNU) alone is not curative, and recurrence and metastasis are likely to occur. Adjuvant chemotherapy (AC) is an evidence-based treatment. However, the optimal number of AC cycles is not clear. This multicenter study investigated the number of cycles required for the beneficial effects of AC in Japanese patients with UTUC.
Patients who were diagnosed with UTUC and underwent RNU at our hospital and affiliated hospitals from January 2010 to September 2020 were included in the study. Patients with pathological T3 or higher or lymph node metastasis were observed or given AC, and their responses were compared. The AC regimens included gemcitabine and cisplatin or carboplatin. Patients were also classified into two groups: the observation and two cycles of AC group and the three to four cycles of AC group. The survival curves for recurrence-free survival (RFS) and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analyses.
Of the 133 patients enrolled in the study, 24 received 2 cycles of AC, 37 received 3-4 cycles, and 72 were observed only. The 5-year RFS was 67.1% for the 3-4 cycles of AC group and 41.7% for the observation and two cycles of AC group. The 5-year CSS was 72.2% for the 3-4 cycles of AC group and 35.9% for the observation and two cycles of AC group. RFS and CSS were significantly longer in the 3-4 cycles of AC group compared to the observation and 2 cycles group ( = 0.048 and = 0.005 respectively).
AC prolonged RFS and CSS in the real-world setting. However, at least three cycles of AC are required to achieve beneficial effects in patients with UTUC.
上尿路尿路上皮癌（UTUC）并不常见。在晚期病例中，单纯根治性肾输尿管切除术（RNU）无法治愈，且复发和转移很可能发生。辅助化疗（AC）是一种基于证据的治疗方法。然而，AC的最佳疗程数尚不清楚。这项多中心研究调查了AC对日本UTUC患者产生有益效果所需的疗程数。
本研究纳入了2010年1月至2020年9月期间在我院及附属医院被诊断为UTUC并接受RNU的患者。对病理分期为T3及以上或有淋巴结转移的患者进行观察或给予AC，并比较他们的反应。AC方案包括吉西他滨和顺铂或卡铂。患者也被分为两组：观察组和AC两周期组，以及AC三至四周期组。采用Kaplan-Meier分析评估无复发生存期（RFS）和癌症特异性生存期（CSS）的生存曲线。
在纳入研究的133例患者中，24例接受了2周期的AC，37例接受了3 - 4周期，72例仅接受观察。AC三至四周期组的5年RFS为67.1%，观察组和AC两周期组为41.7%。AC三至四周期组的5年CSS为72.2%，观察组和AC两周期组为35.9%。与观察组和2周期组相比，AC三至四周期组的RFS和CSS显著更长（分别为P = 0.048和P = 0.005）。
在现实环境中，AC延长了RFS和CSS。然而，UTUC患者至少需要三个周期的AC才能产生有益效果。
