The role of adjuvant chemotherapy for lymph node-positive upper tract urothelial carcinoma following radical nephroureterectomy: a retrospective study.
OBJECTIVE
To evaluate the effect of adjuvant chemotherapy (AC) on mortality after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) with positive lymph nodes (LNs) and to identify patient subgroups that are most likely to benefit from AC.


METHODS
We retrospectively analysed data of 263 patients with LN-positive UTUC, who underwent full surgical resection. In all, 107 patients (41%) received three to six cycles of AC, while 156 (59.3%) were treated with RNU alone. UTUC-related mortality was evaluated using competing-risks regression models.


RESULTS
In all patients (T(all) N+), administration of AC had no significant impact on UTUC-related mortality on univariable (P = 0.49) and multivariable (P = 0.11) analysis. Further stratified analyses showed that only N+ patients with pT3-4 disease benefited from AC. In this subgroup, AC reduced UTUC-related mortality by 34% (P = 0.019). The absolute difference in mortality was 10% after the first year and increased to 23% after 5 years. On multivariable analysis, administration of AC was associated with significantly reduced UTUC-related mortality (subhazard ratio 0.67, P = 0.022). Limitations of this study are the retrospective non-randomised design, selection bias, absence of a central pathological review and different AC protocols.


CONCLUSIONS
AC seems to reduce mortality in patients with pT3-4 LN-positive UTUC after RNU. This subgroup of LN-positive patients could serve as target population for an AC prospective randomised trial.
Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Ilaria
I
Lucca
Department of Urology, McGill University, Montreal, QC, Canada.
Wassim
W
Kassouf
Department of Urology, McMaster University, Hamilton, ON, Canada.
Anil
A
Kapoor
Department of Surgery (Urology), University of Alberta, Edmonton, AB, Canada.
Adrian
A
Fairey
Department Urology, Dalhousie University, Halifax, NS, Canada.
Ricardo A
RA
Rendon
Department of Surgery (Urology), University of Western Ontario, London, ON, Canada.
Jonathan I
JI
Izawa
Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada.
Peter C
PC
Black
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
Harun
H
Fajkovic
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
Christian
C
Seitz
Department of Urology, Landeskrankenhaus Weinviertel-Korneuburg, Korneuburg, Austria.
Mesut
M
Remzi
Department of Urology, Semmelweis University, Budapest, Hungary.
Peter
P
Nyirády
Department of Urology, Groupe Hospitalier Pitié - Salpêtrière, Assistance Publique Hopitaux de Paris, Faculty of Medicine Pierre et Marie Curie, Institut Universitaire de Cancérologie GRC5, University Paris 6, Paris, France.
Morgan
M
Rouprêt
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Vitaly
V
Margulis
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Yair
Y
Lotan
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
Michela
M
de Martino
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
Sebastian L
SL
Hofbauer
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada.
Pierre I
PI
Karakiewicz
Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy.
Alberto
A
Briganti
Department of Surgical, Oncological and Gastroenterologic Sciences, Urology Clinic, University of Padua, Padua, Italy.
Giacomo
G
Novara
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.|Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
Shahrokh F
SF
Shariat
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
Tobias
T
Klatte
D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000601:surgery; D019459:Urothelium / Q000473:pathology / Q000601:surgery
D000970:Antineoplastic Agents
adjuvant chemotherapy; lymph node positive; radical nephroureterectomy; survival; upper tract urothelial carcinoma