Trends in the use of neoadjuvant chemotherapy and oncological outcomes for high-risk upper tract urothelial carcinoma: a multicentre retrospective study.

Autor: Hamaya T; Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Hatakeyama S; Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Tanaka T; Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan., Kubota Y; Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Togashi K; Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Hosogoe S; Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Fujita N; Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Kusaka A; Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Tokui N; Department of Urology, Odate Municipal General Hospital, Odate, Japan., Okamoto T; Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Yamamoto H; Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Yoneyama T; Department of Glycotechnology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Yoneyama T; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Hashimoto Y; Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Ohyama C; Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2021 Oct; Vol. 128 (4), pp. 468-476. Date of Electronic Publication: 2021 Feb 15.
DOI: 10.1111/bju.15346
Abstrakt: Objective: To evaluate temporal trends in neoadjuvant chemotherapy (NAC) utilisation and outcomes in patients with locally advanced upper tract urothelial carcinoma (UTUC).
Patients and Methods: We included 289 patients from seven hospitals who underwent radical nephroureterectomy (RNU) for locally advanced UTUC (≥cT3 or cN+) between 2000 and 2020. These patients received RNU alone or two to four courses of NAC with either a cisplatin- or carboplatin-based regimen. We evaluated the temporal changes in NAC use and compared the visceral recurrence-free, cancer-specific, and overall survival rates. The effect of NAC on oncological outcomes was examined using multivariate Cox regression analysis with inverse probability of treatment weighting (IPTW) models.
Results: Of 289 patients, 144 underwent NAC followed by RNU (NAC group) and 145 underwent RNU alone (Control [Ctrl] group). NAC use increased significantly from 19% (2006-2010), 58% (2011-2015), to 79% (2016-2020). Pathological downstaging was significantly higher in the NAC group than in the Ctrl group. The IPTW-adjusted multivariable analyses showed that NAC significantly improved the oncological outcomes in the NAC group compared with the Ctrl group. Moreover, carboplatin-based NAC significantly improved the oncological outcomes in the NAC group compared with the Ctrl group among patients with chronic kidney disease Stage ≥3. There were no significant differences in oncological outcomes between the cisplatin- and carboplatin-based regimens.
Conclusions: The use of NAC for high-risk UTUC increased significantly after 2010. Platinum-based short-term NAC followed by immediate RNU may not impede and potentially improves oncological outcomes.
(© 2021 The Authors BJU International published by John Wiley & Sons Ltd on behalf of BJU International.)
Databáze: MEDLINE
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