Impact of an Adjuvant Chemotherapeutic Regimen on the Clinical Outcome in High Risk Patients with Upper Tract Urothelial Carcinoma: A Japanese Multi-Institution Experience

No AccessJournal of UrologyAdult Urology1 Apr 2015Impact of an Adjuvant Chemotherapeutic Regimen on the Clinical Outcome in High Risk Patients with Upper Tract Urothelial Carcinoma: A Japanese Multi-Institution Experience Suguru Shirotake, Eiji Kikuchi, Nobuyuki Tanaka, Kazuhiro Matsumoto, Yasumasa Miyazaki, Hiroaki Kobayashi, Hiroki Ide, Jun Obata, Katsura Hoshino, Gou Kaneko, Masayuki Hagiwara, Takeo Kosaka, Kent Kanao, Kiichiro Kodaira, Satoshi Hara, Masafumi Oyama, Tetsuo Momma, Akira Miyajima, Ken Nakagawa, Shintaro Hasegawa, Yosuke Nakajima, and Mototsugu Oya Suguru ShirotakeSuguru Shirotake More articles by this author , Eiji KikuchiEiji Kikuchi More articles by this author , Nobuyuki TanakaNobuyuki Tanaka More articles by this author , Kazuhiro MatsumotoKazuhiro Matsumoto More articles by this author , Yasumasa MiyazakiYasumasa Miyazaki More articles by this author , Hiroaki KobayashiHiroaki Kobayashi More articles by this author , Hiroki IdeHiroki Ide More articles by this author , Jun ObataJun Obata More articles by this author , Katsura HoshinoKatsura Hoshino More articles by this author , Gou KanekoGou Kaneko More articles by this author , Masayuki HagiwaraMasayuki Hagiwara More articles by this author , Takeo KosakaTakeo Kosaka More articles by this author , Kent KanaoKent Kanao More articles by this author , Kiichiro KodairaKiichiro Kodaira More articles by this author , Satoshi HaraSatoshi Hara More articles by this author , Masafumi OyamaMasafumi Oyama More articles by this author , Tetsuo MommaTetsuo Momma More articles by this author , Akira MiyajimaAkira Miyajima More articles by this author , Ken NakagawaKen Nakagawa More articles by this author , Shintaro HasegawaShintaro Hasegawa More articles by this author , Yosuke NakajimaYosuke Nakajima More articles by this author , and Mototsugu OyaMototsugu Oya More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.10.022AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Current guidelines do not yet provide any recommendations for adjuvant chemotherapy in patients with upper tract urothelial carcinoma managed with radical nephroureterectomy. We evaluated whether an adjuvant chemotherapeutic regimen would affect the clinical outcome in patients with high risk upper tract urothelial carcinoma. Materials and Methods: We identified 873 patients who had undergone radical nephrouretectomy for localized upper tract urothelial carcinoma at 14 Japanese institutions between 1993 and 2011. We assessed whether the type of regimen, such as methotrexate, vinblastine, doxorubicin and cisplatin, and gemcitabine and cisplatin, in an adjuvant setting, could affect the subsequent clinical outcome of patients with upper tract urothelial carcinoma. Results: On multivariate analysis pathological T stage, tumor grade, lymphovascular invasion and lymph node involvement were prognostic factors for recurrence-free survival and cancer specific survival. We defined 229 patients with 3 or more of these factors as the high risk group. In an analysis according to adjuvant regimen, Kaplan-Meier curves showed that the 1 and 2-year recurrence-free survival rates in the methotrexate, vinblastine, doxorubicin and cisplatin treated group were 71.4% and 47.9%, which were significantly higher than in the gemcitabine and cisplatin treated group (48.2% and not reached, p=0.022) or those not treated with adjuvant chemotherapy (53.4% and 39.6%, p=0.039). Similar results were observed in terms of cancer specific survival. Conclusions: Our study showed that pT3-4, tumor grade 3, positive lymphovascular invasion and lymph node involvement were independent risk factors for disease mortality in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy. In the high risk group methotrexate, vinblastine, doxorubicin and cisplatin adjuvant chemotherapy contributed to improve subsequent mortality compared to gemcitabine and cisplatin or no adjuvant chemotherapy. 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Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byLaguna M (2017) Re: Efficacy of Systemic Chemotherapy plus Radical Nephroureterectomy for Metastatic Upper Tract Urothelial CarcinomaJournal of Urology, VOL. 198, NO. 6, (1205-1206), Online publication date: 1-Dec-2017.Laguna M (2017) Re: Effectiveness of Adjuvant Chemotherapy after Radical Nephroureterectomy for Locally Advanced and/or Positive Regional Lymph Node Upper Tract Urothelial CarcinomaJournal of Urology, VOL. 198, NO. 4, (739-740), Online publication date: 1-Oct-2017.Steers W (2015) This Month in Adult UrologyJournal of Urology, VOL. 193, NO. 4, (1077-1078), Online publication date: 1-Apr-2015. Volume 193Issue 4April 2015Page: 1122-1128Supplementary Materials Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordsurinary tractcarcinomatransitional cellchemotherapyadjuvanttreatment outcomeMetrics Author Information Suguru Shirotake More articles by this author Eiji Kikuchi More articles by this author Nobuyuki Tanaka More articles by this author Kazuhiro Matsumoto More articles by this author Yasumasa Miyazaki More articles by this author Hiroaki Kobayashi More articles by this author Hiroki Ide More articles by this author Jun Obata More articles by this author Katsura Hoshino More articles by this author Gou Kaneko More articles by this author Masayuki Hagiwara More articles by this author Takeo Kosaka More articles by this author Kent Kanao More articles by this author Kiichiro Kodaira More articles by this author Satoshi Hara More articles by this author Masafumi Oyama More articles by this author Tetsuo Momma More articles by this author Akira Miyajima More articles by this author Ken Nakagawa More articles by this author Shintaro Hasegawa More articles by this author Yosuke Nakajima More articles by this author Mototsugu Oya More articles by this author Expand All Advertisement PDF downloadLoading ...