title: Do metastatic upper tract urothelial carcinoma and bladder carcinoma have similar clinical responses to systemic chemotherapy? A Japanese multi-institutional experience.
abstract: OBJECTIVE
  There has been no clear evidence supporting similar chemo-responses for upper and lower urothelial carcinomas.
  
  
  METHODS
  We conducted a multicenter retrospective cohort study to analyze urothelial carcinoma patients who underwent systemic chemotherapy at 17 centers from 2004 to 2010. A total of 298 patients with either urothelial carcinoma of the bladder (N = 151) or upper tract urothelial carcinoma (N = 147) were included. Differences in tumor location (urothelial carcinoma of the bladder vs. upper tract urothelial carcinoma) were evaluated in relation to the patient backgrounds and clinical responses to systemic chemotherapy.
  
  
  RESULTS
  Overall 216 patients were treated with cisplatin-based chemo-regimens (gemcitabine and cisplatin in 92, or methotrexate, vinblastine, adriamycin and cisplatin/methotrexate, epirubicin and cisplatin in 124). Among 186 initially metastatic patients, the incidences of lung metastasis and liver metastasis were 39.2 and 34.1%, respectively, in upper tract urothelial carcinoma patients, and were significantly higher than those with urothelial carcinoma of the bladder (22.4% for lung; 8.4% for liver metastasis). Among 112 post-surgical recurrent/metastatic patients, age was significantly higher and estimated glomerular filtration rate at baseline was significantly lower in upper tract urothelial carcinoma patients than those with urothelial carcinoma of the bladder. No significant differences were observed in overall clinical response rates for systemic chemotherapy between urothelial carcinoma of the bladder (45.8%) and upper tract urothelial carcinoma (38%) in initially metastatic patients or between urothelial carcinoma of the bladder (43.2%) and upper tract urothelial carcinoma (44.1%) in post-surgical recurrent/metastatic patients. Tumor location was not independently associated with cancer-specific survival in either initially metastatic or post-surgical recurrent/metastatic urothelial carcinoma patients.
  
  
  CONCLUSIONS
  No significant difference was observed in response rates of urothelial carcinoma of the bladder and upper tract urothelial carcinoma to systemic chemotherapy, suggesting that a similar chemo-regimen can be applied to metastatic urothelial carcinoma patients regardless of tumor location (upper vs. lower).
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.affiliation: Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba.
authors.forename: Jun
authors.initials: J
authors.lastname: Miyazaki
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Yuge
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hagiwara
authors.affiliation: Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba.
authors.forename: Daishi
authors.initials: D
authors.lastname: Ichioka
authors.affiliation: Department of Urology, Akita University School of Medicine, Akita.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Urology, Shiga University of Medical Science, Otsu.
authors.forename: Susumu
authors.initials: S
authors.lastname: Kageyama
authors.affiliation: Department of Urology, Faculty of Medicine, Kagawa University, Takamatsu.
authors.forename: Mikio
authors.initials: M
authors.lastname: Sugimoto
authors.affiliation: Department of Urology, Graduate School of Medicine, Tohoku University, Sendai.
authors.forename: Koji
authors.initials: K
authors.lastname: Mitsuzuka
authors.affiliation: Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Matsui
authors.affiliation: Department of Urology, Hyogo College of Medicine, Nishinomiya.
authors.forename: Shingo
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Hirakata.
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Wakeda
authors.affiliation: Department of Urology, Tokai University Hospital, Isehara.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Hanai
authors.affiliation: Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba Tsukuba Critical Path Research and Education Integrated Leading Center, Tsukuba, Japan nishiuro@md.tsukuba.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishiyama
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology; D014571:Urologic Neoplasms / Q000188:drug therapy; D014747:Vinblastine / Q000008:administration & dosage; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate; D000093542:Gemcitabine
keywords: bladder; metastasis; outcome; upper urinary tract; urothelial carcinoma