Oncological outcomes of neoadjuvant chemotherapy in patients with locally advanced upper tract urothelial carcinoma: a multicenter study
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Yuka Kubota1, Shingo Hatakeyama1, Toshikazu Tanaka1, Naoki Fujita1, Hiromichi Iwamura2, Jotaro Mikami1, Hayato Yamamoto1, Yuki Tobisawa1, Tohru Yoneyama3, Takahiro Yoneyama1, Yasuhiro Hashimoto3, Takuya Koie1, Hiroyuki Ito4, Kazuaki Yoshikawa5, Atsushi Sasaki6, Toshiaki Kawaguchi7 and Chikara Ohyama1,3
1Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
2Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
3Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
4Department of Urology, Aomori Rosai Hospital, Hachinohe, Japan
5Department of Urology, Mutsu General Hospital, Mutsu, Japan
6Department of Urology, Tsugaru General Hospital, Goshogawara, Japan
7Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan
Shingo Hatakeyama, email: firstname.lastname@example.org
Keywords: carboplatin, chemotherapy, cisplatin, neoadjuvant, upper tract urothelial carcinoma
Received: July 05, 2017 Accepted: September 21, 2017 Published: October 06, 2017
Objective: The clinical impact of neoadjuvant chemotherapy (NAC) on oncological outcomes in patients with locally advanced upper tract urothelial carcinoma (UTUC) remains unclear. We investigated the oncological outcomes of platinum-based NAC for locally advanced UTUC.
Results: Of 234 patients, 101 received NAC (NAC group) and 133 did not (Control [Ctrl] group). The regimens in the NAC group included gemcitabine and carboplatin (75%), and gemcitabine and cisplatin (21%). Pathological downstagings of the primary tumor and lymphovascular invasion were significantly improved in the NAC than in the Ctrl groups. NAC for locally advanced UTUC significantly prolonged recurrence-free and cancer-specific survival. Multivariate Cox regression analysis using an inverse probability of treatment weighted (IPTW) method showed that NAC was selected as an independent predictor for prolonged recurrence-free and cancer-specific survival. However, the influence of NAC on overall survival was not statistically significant.
Materials and Methods: A total of 426 patients who underwent radical nephroureterectomy at five medical centers between January 1995 and April 2017 were examined retrospectively. Of the 426 patients, 234 were treated for a high-risk disease (stages cT3–4 or locally advanced [cN+] disease) with or without NAC. NAC regimens were selected based on eligibility of cisplatin. We retrospectively evaluated post-therapy pathological downstaging, lymphovascular invasion, and prognosis stratified by NAC use. Multivariate Cox regression analysis was performed for independent factors for prognosis.
Conclusions: Platinum-based NAC for locally advanced UTUC potentially improves oncological outcomes. Further prospective studies are needed to clarify the clinical benefit of NAC for locally advanced UTUC.
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