title: Adjuvant methotrexate, vinblastine, adriamycin, and cisplatin chemotherapy has potential to prevent recurrence of bladder tumors after surgical removal of upper urinary tract transitional cell carcinoma.
abstract: OBJECTIVE
  To evaluate the efficacy of adjuvant platinum based chemotherapy in upper urinary tract urothelial cancer following surgical resection in terms of survival benefit and inhibition of bladder cancer recurrence.
  
  
  METHODS
  Between April 1986 and August 2005, a total of 132 patients with a diagnosis of upper urinary tract urothelial cancer underwent radical nephroureterectomy with cuff of bladder at our department. A total of 46 patients (13 with pT2pN0M0 and 33 with pT3 pN0M0 transitional cell carcinoma without prior bladder cancer) were enrolled. Patients with locally advanced disease were divided into two groups: the adjuvant chemotherapy group (24 patients) who received adjuvant methotrexate, vinblastine, adriamycin, and cisplatin (M-VAC) and the non-adjuvant chemotherapy group who did not receive adjuvant M-VAC (22 patients).
  
  
  RESULTS
  There were no statistically significant differences in patient characteristics or 10-year survival between the two groups. The recurrence rate in the non-adjuvant chemotherapy group was significantly higher than in the adjuvant chemotherapy group (log-rank test, P < 0.0001). Only non-adjuvant chemotherapy was a significant and independent risk factor (hazard ratio 6.97) for the development of intravesical recurrence (P < 0.01).
  
  
  CONCLUSIONS
  Adjuvant M-VAC is an important optional adjuvant therapy and can prevent recurrent bladder tumors following surgery for upper urinary tract transitional cell carcinoma. To determine whether adjuvant chemotherapy has further benefit, a randomized study would be needed.
authors.affiliation: Department of Reparative and Regenerative Medicine, Division of Nephro-Urologic Surgery and Andrology, Institute of Medical Life Science, Mie University Graduate School of Medicine, Tsu, Mie, Japan. n-soga@clin.medic.mie-u.ac.jp
authors.forename: Norihito
authors.initials: N
authors.lastname: Soga
authors.forename: Kiminobu
authors.initials: K
authors.lastname: Arima
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sugimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000517:prevention & control* / Q000601:surgery*; D016022:Case-Control Studies; D002945:Cisplatin / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D016609:Neoplasms, Second Primary / Q000517:prevention & control*; D009392:Nephrectomy; D014516:Ureteral Neoplasms / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000517:prevention & control*; D014747:Vinblastine / Q000627:therapeutic use
chemical_list: D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate