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Efficacy of post-nephroureterectomy cisplatin-based adjuvant chemotherapy for locally advanced upper tract urothelial carcinoma: a multi-institutional retrospective study

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Abstract

Purpose

To evaluate the efficacy of adjuvant systemic chemotherapy for locally advanced (pT3-4pN0/xM0) upper tract urothelial carcinoma (UTUC).

Materials and methods

We retrospectively reviewed the medical records of 109 patients with pT3-4pN0/xM0 UTUC who had undergone radical nephroureterectomy between 1996 and 2013 at our four institutions. The patients were divided into two groups: those who received adjuvant chemotherapy (AC group) and those who did not (surgery-alone: SA group). All chemotherapy regimens were cisplatin-based. Cox proportional hazards regression models addressed the associations between clinicopathological factors and recurrence-free survival (RFS) and cancer-specific survival (CSS).

Results

Forty-three (39.5%) out of the 109 patients underwent one to four cycles of adjuvant chemotherapy after nephroureterectomy. Median follow-up was 46.5 months. There were no significant differences in the background characteristics of the two groups, except for age. Recurrence developed in 11 (25.6%) and 29 (43.9%) patients in the AC and SA groups, respectively. Ultimately, six (14.0%) and 18 (27.3%) patients in the AC and SA groups, respectively, died of disease progression. On univariate analysis, hydronephrosis, nuclear grade, lymphovascular invasion, and adjuvant chemotherapy were significantly associated with both RFS and CSS. Charlson comorbidity index was associated only with CSS. On multivariate analysis, adjuvant chemotherapy was the only independent factor associated with improved RFS (p = 0.0178, HR = 0.41). Moreover, adjuvant chemotherapy (p = 0.0375, HR = 0.33), lower nuclear grade (p = 0.0070), and the absence of hydronephrosis (p = 0.0493) were independently associated with better CSS.

Conclusion

Locally advanced (pT3-4pN0/xM0) UTUC patients who underwent cisplatin-based adjuvant chemotherapy demonstrated better RFS and CSS than those without adjuvant chemotherapy.

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Abbreviations

UTUC:

Upper tract urothelial carcinoma

RFS:

Recurrence-free survival

CSS:

Cancer-specific survival

RCT:

Randomized controlled trial

AC:

Adjuvant chemotherapy

SA:

Surgery-alone

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Acknowledgements

We received no funding/grant support for this study.

Author information

Author notes

  1. Tohru Nakagawa and Yoshimitsu Komemushi have contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Tohru Nakagawa, Yoshimitsu Komemushi, Taketo Kawai, Masafumi Otsuka, Jimpei Miyakawa, Atsushi Kanatani, Satoru Taguchi, Akihiro Naito, Akihiko Matsumoto, Hideyo Miyazaki, Tetsuya Fujimura, Hiroshi Fukuhara, Haruki Kume, Yasuhiko Igawa & Yukio Homma

  2. Department of Urology, The Fraternity Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan

    Yoshimitsu Komemushi, Hiroaki Nishimatsu & Yoshikazu Hirano

  3. Department of Urology, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino-shi, Tokyo, 180-8610, Japan

    Taketo Kawai, Masafumi Otsuka & Yoshinori Tanaka

  4. Department of Urology, Tokyo Teishin Hospital, 2-14-23 Fujimi, Chiyoda-ku, Tokyo, 102-8798, Japan

    Jimpei Miyakawa, Satoru Taguchi & Motofumi Suzuki

  5. Biostatistics Division, Central Coordinating Unit, Clinical Research Support Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Yukari Uemura

Authors
  1. Tohru Nakagawa
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  2. Yoshimitsu Komemushi
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  3. Taketo Kawai
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Contributions

T. Nakagawa: Project development, Data management, Data analysis, Manuscript writing. Y. Komemushi: Project development, Data Collection, Data analysis, Manuscript writing. T. Kawai: Data Collection, Data analysis, Manuscript editing. M. Otsuka: Data Collection, Data analysis, Manuscript editing. J. Miyakawa: Data Collection, Data analysis, Manuscript editing. Y. Uemura: Data analysis, Manuscript editing. A. Kanatani: Data Collection, Data analysis, Manuscript editing. S. Taguchi: Data Collection, Data analysis, Manuscript editing. A. Naito: Data Collection, Data analysis, Manuscript editing. M. Suzuki: Data management, Data analysis, Manuscript editing. H. Nishimatsu: Data management, Data analysis, Manuscript editing. Y. Hirano: Data management, Data analysis, Manuscript editing. Y. Tanaka: Data management, Data analysis, Manuscript editing. A. Matsumoto: Data analysis, Manuscript editing. H. Miyazaki: Data analysis, Manuscript editing. T. Fujimura: Data analysis, Manuscript editing. H. Fukuhara: Data analysis, Manuscript editing. H. Kume: Data analysis, Manuscript editing, Administrative support. Y. Igawa: Data analysis, Manuscript editing. Y. Homma: Manuscript editing, Administrative support, Supervision

Corresponding author

Correspondence to Tohru Nakagawa.

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This study has been approved by the appropriate ethics committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. For this type of study, formal consent is not required.

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The authors declare that they have no conflict of interest.

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Nakagawa, T., Komemushi, Y., Kawai, T. et al. Efficacy of post-nephroureterectomy cisplatin-based adjuvant chemotherapy for locally advanced upper tract urothelial carcinoma: a multi-institutional retrospective study. World J Urol 35, 1569–1575 (2017). https://doi.org/10.1007/s00345-017-2032-6

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  • DOI: https://doi.org/10.1007/s00345-017-2032-6

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