title: Outcomes after adjuvant chemotherapy in the treatment of high-risk urothelial carcinoma of the upper urinary tract (UUT-UC): results from a large multicenter collaborative study.
abstract: BACKGROUND
  Urothelial carcinoma of the upper urinary tract (UUT-UC) was a rare, aggressive urologic cancer with a propensity for multifocality, local recurrence, and metastasis. High-risk patients had poor outcomes. Because of the rarity of these tumors, randomized clinical trials and data regarding adjuvant chemotherapy in locally advanced tumors are currently unavailable. Our objective was to assess the effect of adjuvant chemotherapy and the impact of potential prognostic factors on survival in high-risk, postsurgical UUT-UC patients.
  
  
  METHODS
  Using a multi-institutional, international retrospective database, identified were 627 patients with high risk UUT-UCs (pT3N0, pT4N0 and/or N+ and/or M+) who underwent surgical removal. Only patients who received adjuvant chemotherapy were included.
  
  
  RESULTS
  Overall, 140 patients (22.6%) with a median age of 67 years were included. The median follow-up was 22.5 months. The 5-year, overall survival for the entire cohort was 43%, the 5-year recurrence-free survival was 54%, and metastasis-free survival was 53% at 5 years. Positive surgical margins were an independent prognostic factor for recurrence (P = .06), cancer-specific mortality (P = .05), and overall mortality (P = .02) of any cause. Adjuvant chemotherapy was not linked with overall or cancer-specific survival in patients with high risk disease (adjuvant chemotherapy [n = 140] vs no treatment [n = 487]) (P >.5).
  
  
  CONCLUSIONS
  Adjuvant postoperative chemotherapy did not offer any significant benefit to overall survival in our population. Additional data were necessary, and studies enrolling patients at high risk in clinical trials investigating neoadjuvant chemotherapy in conjunction with chemotherapy should have been highly encouraged.
authors.affiliation: Academic Department of Medical Oncology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.
authors.forename: Maria
authors.initials: M
authors.lastname: Vassilakopoulou
authors.forename: Thibault
authors.initials: T
authors.lastname: de la Motte Rouge
authors.forename: Pierre
authors.initials: P
authors.lastname: Colin
authors.forename: Adil
authors.initials: A
authors.lastname: Ouzzane
authors.forename: David
authors.initials: D
authors.lastname: Khayat
authors.forename: Meletios-Athanasios
authors.initials: MA
authors.lastname: Dimopoulos
authors.forename: Christos A
authors.initials: CA
authors.lastname: Papadimitriou
authors.forename: Aristotle
authors.initials: A
authors.lastname: Bamias
authors.forename: Géraldine
authors.initials: G
authors.lastname: Pignot
authors.forename: François Xavier
authors.initials: FX
authors.lastname: Nouhaud
authors.forename: Sophie
authors.initials: S
authors.lastname: Hurel
authors.forename: Laurent
authors.initials: L
authors.lastname: Guy
authors.forename: Pierre
authors.initials: P
authors.lastname: Bigot
authors.forename: Mathieu
authors.initials: M
authors.lastname: Roumiguié
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D002945:Cisplatin