title: Upper urinary tract urothelial carcinoma with loco-regional nodal metastases: insights from the Upper Tract Urothelial Carcinoma Collaboration.
abstract: OBJECTIVE
  • To describe a multicentre experience with preoperative platinum-based chemotherapy before radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC) with loco-regional nodal metastases.
  
  
  METHODS
  • We identified 313 patients from the UTUC Collaboration (over 1200 patients), who underwent RNU with concomitant retroperitoneal lymph node dissection between 1990 and 2007 and met the inclusion criteria for one of three groups. • Group 1 comprised patients who received chemotherapy before RNU because of biopsy-proven loco-regional nodal metastases. • Group 2 consisted of patients who underwent primary RNU and were found to have metastatic nodal disease on final pathological review (node-positive). • Group 3 comprised a comparative cohort of patients treated with primary RNU for invasive or locally advanced (pT2/pT4) node-negative (N0) UTUC.
  
  
  RESULTS
  • Groups 1, 2 and 3 included 18, 120 and 175 patients, respectively. The 5-year disease-free survival rates were 49%, 30% and 64%, whereas the 5-year cancer-specific survival rates were 44%, 36% and 69% in groups 1, 2 and 3, respectively. • In group 1, on final pathological evaluation, nine patients were pN0, six patients were pT0 and five patients had pT0N0 disease. Kaplan-Meier survival analyses showed similar recurrence and survival rates in group 1 compared with group 3 (P= 0.14 and P= 0.06, respectively). • Meanwhile, group 2 had significantly lower disease-free and cancer-specific survival rates compared with group 3 (P < 0.001 and P < 0.001, respectively) and compared with group 1 (P= 0.04 and P= 0.06, respectively).
  
  
  CONCLUSIONS
  • Preoperative chemotherapy followed by aggressive surgical consolidation may yield favourable oncological outcomes in patients with UTUC with loco-regional nodal metastases. • These data support further evaluation of neoadjuvant systemic therapy in patients at risk for locally advanced UTUC.
authors.affiliation: UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Ramy F
authors.initials: RF
authors.lastname: Youssef
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Alon
authors.initials: A
authors.lastname: Weizer
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.forename: Wareef
authors.initials: W
authors.lastname: Kabbani
authors.forename: Cord
authors.initials: C
authors.lastname: Langner
authors.forename: Charles C
authors.initials: CC
authors.lastname: Guo
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D010537:Peritoneum; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D019459:Urothelium / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents