title: Adjuvant chemotherapy for high risk upper tract urothelial carcinoma: results from the Upper Tract Urothelial Carcinoma Collaboration.
abstract: OBJECTIVE
  There is relatively little literature on adjuvant chemotherapy after radical nephroureterectomy in patients with upper tract urothelial carcinoma. We determined the incidence of adjuvant chemotherapy in high risk patients and the ensuing effect on overall and cancer specific survival.
  
  
  METHODS
  Using an international collaborative database we identified 1,390 patients who underwent nephroureterectomy for nonmetastatic upper tract urothelial carcinoma between 1992 and 2006. Of these cases 542 (39%) were classified as high risk (pT3N0, pT4N0 and/or lymph node positive). These patients were divided into 2 groups, including those who did and did not receive adjuvant chemotherapy, and stratified by gender, age group, performance status, and tumor grade and stage. Cox proportional hazard modeling and Kaplan-Meier analysis were used to determine overall and cancer specific survival in the cohorts.
  
  
  RESULTS
  Of high risk patients 121 (22%) received adjuvant chemotherapy. Adjuvant chemotherapy was more commonly administered in the context of increased tumor grade and stage (p <0.001). Median survival in the entire cohort was 24 months (range 0 to 231). There was no significant difference in overall or cancer specific survival between patients who did and did not receive adjuvant chemotherapy. However, age, performance status, and tumor grade and stage were significant predictors of overall and cancer specific survival.
  
  
  CONCLUSIONS
  Adjuvant chemotherapy is infrequently used to treat high risk upper tract urothelial carcinoma after nephroureterectomy. Despite this finding it appears that adjuvant chemotherapy confers minimal impact on overall or cancer specific survival in this group.
authors.affiliation: University of California-Davis, Sacramento, California 95817, USA. nicholas.hellenthal@ucdmc.ucdavis.edu
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Hellenthal
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.forename: Alon
authors.initials: A
authors.lastname: Weizer
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Casey K
authors.initials: CK
authors.lastname: Ng
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Oya
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Mario
authors.initials: M
authors.lastname: Fernandez
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Evans
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Koppie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D016019:Survival Analysis; D014516:Ureteral Neoplasms / Q000188:drug therapy* / Q000601:surgery