TY - JOUR
T1 - Survival effect of perioperative systemic chemotherapy on overall mortality in locally advanced and/or positive regional lymph node non-metastatic urothelial carcinoma of the upper urinary tract
AU - Nazzani, Sebastiano
AU - Preisser, Felix
AU - Mazzone, Elio
AU - Tian, Zhe
AU - Mistretta, Francesco A.
AU - Shariat, Shahrokh F.
AU - Soulières, Denis
AU - Saad, Fred
AU - Montanari, Emanuele
AU - Luzzago, Stefano
AU - Briganti, Alberto
AU - Carmignani, Luca
AU - Karakiewicz, Pierre I.
PY - 2019
Y1 - 2019
N2 - Objectives: To analyze the potential survival benefit of perioperative chemotherapy (CHT) in patients treated with nephroureterectomy (NU) for non-metastatic locally advanced upper tract urothelial carcinoma. Methods: Within the Surveillance, Epidemiology, and End Results database (2004–2014), we identified 1286 patients with T3 or T4, N 0–3 M0 UTUC. Kaplan–Meier plots, as well as multivariable Cox regression models (MCRMs) relying on inverse probability after treatment weighting (IPTW) and landmark analyses, were used to test the effect of CHT vs no CHT on overall mortality (OM) in the overall population (n =1286), as well as after stratification according to lymph node invasion (LNI). Results: Overall, 37.4% patients received CHT. The CHT rate was higher with LNI (62.2% vs 35.2%, p < 0.001). In MCRMs, testing for OM in the overall population, CHT was associated with lower rates of OM (HR 0.71, CI 0.58–0.87; p = 0.001). Similarly, in MCRMs testing for OM in patients with LNI, CHT achieved independent predictor status for lower OM (HR 0.61, CI 0.48–0.78; p < 0.001). Conversely, in MCRMs testing for OM in patients without LNI, no CHT effect was recorded (HR 0.72, CI 0.52–1.01; p = 0.05). All results were confirmed after IPTW adjustment and in landmark analyses. Conclusions: Our results represent a contemporary North American report indicating lower OM after CHT for patients with locally advanced non-metastatic upper tract urothelial carcinoma, specifically in patients with T3–T4, N1–N3, M0 disease. Validation of the current and of the previous study is required within a randomized prospective design.
AB - Objectives: To analyze the potential survival benefit of perioperative chemotherapy (CHT) in patients treated with nephroureterectomy (NU) for non-metastatic locally advanced upper tract urothelial carcinoma. Methods: Within the Surveillance, Epidemiology, and End Results database (2004–2014), we identified 1286 patients with T3 or T4, N 0–3 M0 UTUC. Kaplan–Meier plots, as well as multivariable Cox regression models (MCRMs) relying on inverse probability after treatment weighting (IPTW) and landmark analyses, were used to test the effect of CHT vs no CHT on overall mortality (OM) in the overall population (n =1286), as well as after stratification according to lymph node invasion (LNI). Results: Overall, 37.4% patients received CHT. The CHT rate was higher with LNI (62.2% vs 35.2%, p < 0.001). In MCRMs, testing for OM in the overall population, CHT was associated with lower rates of OM (HR 0.71, CI 0.58–0.87; p = 0.001). Similarly, in MCRMs testing for OM in patients with LNI, CHT achieved independent predictor status for lower OM (HR 0.61, CI 0.48–0.78; p < 0.001). Conversely, in MCRMs testing for OM in patients without LNI, no CHT effect was recorded (HR 0.72, CI 0.52–1.01; p = 0.05). All results were confirmed after IPTW adjustment and in landmark analyses. Conclusions: Our results represent a contemporary North American report indicating lower OM after CHT for patients with locally advanced non-metastatic upper tract urothelial carcinoma, specifically in patients with T3–T4, N1–N3, M0 disease. Validation of the current and of the previous study is required within a randomized prospective design.
KW - Chemotherapy
KW - Positive lymph nodes
KW - SEER
KW - Upper urinary tract
KW - Urothelial carcinoma
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U2 - 10.1007/s00345-018-2516-z
DO - 10.1007/s00345-018-2516-z
M3 - Article
AN - SCOPUS:85054715261
VL - 37
SP - 1329
EP - 1337
JO - World Journal of Urology
JF - World Journal of Urology
SN - 0724-4983
IS - 7
ER -