title: The Efficacy of Postoperative Adjuvant Chemotherapy for Patients with pT3N0M0 Upper Tract Urothelial Carcinoma.
abstract: OBJECTIVE
  Nephroureterectomy with bladder cuff excision may not be sufficient as monotherapy for patients with pT3N0M0 upper tract urothelial carcinoma. The efficacy of postoperative adjuvant chemotherapy in this setting remains controversial. We evaluated the efficacy of adjuvant chemotherapy for patients with pT3N0M0 upper tract urothelial carcinoma in overall, cancer specific and recurrence-free survival.
  
  
  METHODS
  We retrospectively reviewed records on 171 consecutive patients with pT3N0M0 upper tract urothelial carcinoma treated with radical nephroureterectomy between 2004 and 2014 at 2 branches of the same institution. Postoperative adjuvant chemotherapy was gemcitabine/cisplatin or cisplatin/fluorouracil/leucovorin. Overall, cancer specific and recurrence-free survival rates were estimated using the Kaplan-Meier method. The values of prognostic factors were evaluated by Cox regression analysis.
  
  
  RESULTS
  Postoperative adjuvant chemotherapy was administered in 60 patients vs nonadjuvant therapy in 111 patients. Median followup was 35.8 months. Between the adjuvant and nonadjuvant treatment groups there were statistically significant differences in 5-year cancer specific (80.5% vs 57.6%, p = 0.010) and recurrence-free (74.4% vs 52.9%, p = 0.026) survival rates. Although there was no statistically significant difference in overall survival (71.9% vs 49.0%, p = 0.072), there was a trend of better overall survival in the patients who received postoperative chemotherapy. On multivariable analysis age (p = 0.018), tumor location (p = 0.003) and adjuvant chemotherapy (p = 0.001) were predictors of cancer specific survival.
  
  
  CONCLUSIONS
  Adjuvant chemotherapy improves cancer specific and recurrence-free survival in patients with pT3N0M0 upper tract urothelial carcinoma after radical nephroureterectomy.
authors: Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: chrishyc@gmail.com.
authors: Yun-Ching
authors: YC
authors: Huang
authors: Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors: Miao-Fen
authors: MF
authors: Chen
authors: Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Chung-Sheng
authors: CS
authors: Shi
authors: Department of Urology, University of California, Davis, California.
authors: Alan W
authors: AW
authors: Shindel
authors: Department of Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors: Cih-En
authors: CE
authors: Huang
authors: Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors: See-Tong
authors: ST
authors: Pang
authors: Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors: Cheng-Keng
authors: CK
authors: Chuang
authors: Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors: Chih-Shou
authors: CS
authors: Chen
authors: Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors: Ying-Hsu
authors: YH
authors: Chang
authors: Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors: Wei-Yu
authors: WY
authors: Lin
authors: Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors: Dong-Ru
authors: DR
authors: Ho
authors: Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors: Chih-Chien
authors: CC
authors: Chin
authors: Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors: Yi-Hung
authors: YH
authors: Kuo
authors: Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan. Electronic address: wuchingf@ms3.hinet.net.
authors: Ching-Fang
authors: CF
authors: Wu
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009392:Nephrectomy; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: adjuvant; carcinoma; chemotherapy; transitional cell; urinary tract