title: Effect of preoperative chemotherapy on survival of patients with upper urinary tract urothelial carcinoma clinically involving regional lymph nodes.
abstract: To determine the effect of preoperative chemotherapy on survival in patients with upper urinary tract urothelial carcinoma clinically involving regional lymph nodes.
  
  
  
  We retrospectively analyzed 55 consecutive patients who received radical nephroureterectomy with or without preoperative chemotherapy for upper urinary tract urothelial carcinoma clinically involving regional lymph nodes at a single institution between January 1991 and December 2013.
  
  
  
  Median follow up was 18 months (range 2-193). Of 55 patients, 24 (43.6%) received preoperative chemotherapy (study group) and 31 (56.4%) underwent primary surgery (control group). Preoperative chemotherapy consisted of two to four cycles (median 3) of cisplatin-containing regimens. The fraction of patients with lower pathological T stage and N stage than clinical T stage and N stage was higher in the study group (29.2% and 54.2%) compared with the control group (3.2% and 16.1%; P = 0.013 and 0.010, respectively). The 5-year overall survival rate was significantly higher in the study group than in the control group (44.0% vs 12.9%, log-rank, P = 0.003). In multivariate analysis incorporating age at diagnosis, Eastern Cooperative Oncology Group Performance Status, clinical N stage and the number of removed lymph nodes, preoperative chemotherapy was a predictor of better overall survival (P = 0.047, HR 0.47, 95% CI 0.22-0.99).
  
  
  
  Preoperative chemotherapy might provide better survival outcomes in patients with upper urinary tract urothelial carcinoma clinically involving regional lymph nodes.
authors.affiliation: Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Saito
authors.affiliation: Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kitamura
authors.affiliation: Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.|Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Bilim
authors.affiliation: Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.|Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Toba
authors.affiliation: Department of Pathology, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawasaki
authors.affiliation: Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.|Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.|Division of Molecular Oncology, Department of Signal Transduction Research, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Hara
authors.affiliation: Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Tanikawa
authors.affiliation: Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Tomita
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D008198:Lymph Nodes; D008207:Lymphatic Metastasis; D009392:Nephrectomy; D012189:Retrospective Studies; D014516:Ureteral Neoplasms / Q000188:drug therapy* / Q000601:surgery; D014551:Urinary Tract
keywords: chemotherapy; lymph node metastasis; neoadjuvant; nephroureterectomy; upper urinary tract urothelial carcinoma