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

Autor: Shingo Hatakeyama, Ayumu Kusaka, Tomoko Hamaya, Toshikazu Tanaka, Chikara Ohyama, Kyo Togashi, Yuka Kubota, Hayato Yamamoto, Shogo Hosogoe, Noriko Tokui, Teppei Okamoto, Yasuhiro Hashimoto, Takahiro Yoneyama, Tohru Yoneyama, Naoki Fujita
Rok vydání: 2021
Předmět:
Male
#uroonc
medicine.medical_specialty
Time Factors
Urology
medicine.medical_treatment
030232 urology & nephrology
Nephroureterectomy
Risk Assessment
survival
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
medicine
Humans
Stage (cooking)
Aged
Retrospective Studies
Aged
80 and over
Cisplatin
Carcinoma
Transitional Cell
Chemotherapy
Ureteral Neoplasms
Proportional hazards model
business.industry
Retrospective cohort study
Original Articles
Middle Aged
upper tract urothelial carcinoma
medicine.disease
Kidney Neoplasms
Neoadjuvant Therapy
Carboplatin
Regimen
Treatment Outcome
trend
chemistry
#utuc
030220 oncology & carcinogenesis
Female
Original Article
business
Procedures and Techniques Utilization
chronic kidney disease
neoadjuvant chemotherapy
Kidney disease
medicine.drug
Zdroj: Bju International
ISSN: 1464-410X
1464-4096
Popis: 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.
Databáze: OpenAIRE
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