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The progression of disease after radical nephroureterectomy and bladder cuff excision relate with uniformly poor survival are common in upper urinary tract transitional cell carcinoma (especially in high-risk patient). The method to improve survival and clinical outcome may are neoadjuvant systemic chemotherapy. We record results and early survival rates compare between neoadjuvant group and surgery as first step group.
Retrospective review of patients who received neoadjuvant chemotherapy following by surgery in 2014-2017 (study group), compared to a matched cohort who underwent radical nephroureterectomy with bladder cuff excision as first step of treatment in the same period (control group). The Fisher exact, Wilcoxon rank-sum and Kaplan-Meier methods were used. The log-rank test and Cox proportional hazards model were used to evaluate association of these two outcomes with patients, treatment and tumor characteristics in univariate and multivariate models.
of 35 patients, 15 were in the study group and 20 in the control group. Neoadjuvant systemic therapy group had improved overall survival (OS) and disease specific survival (DSS) in early 2-year of follow-up protocol ( 2-year OS and DSS was 80.2% and 90.1% in study group, versus 57.6% in control group). In multivariate analyses the study group had a lower risk of mortality (OS hazard ratio 0.42 [p = 0.035]; DSS hazard ratio 0.19 [p = 0.006])
Neoadjuvant with systemic therapy improves survival of high-risk patient with upper urinary tract transitional cell carcinoma with matched historical cohort fo patients treated with initial radical nephroureterectomy with bladder cuff excision.
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