2-years result of neoadjuvant chemotherapy for upper urinary tact transitional cell carcinoma

Main Article Content

Rangsima Marikatat

Abstract

Background


            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.


 


Methods


            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.


 


Result


            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])


 


Conclusions


            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.

Keywords

Article Details

How to Cite
Marikatat, R. (2019). 2-years result of neoadjuvant chemotherapy for upper urinary tact transitional cell carcinoma. The Thai Journal of Urology, 40(1). Retrieved from https://www.tci-thaijo.org/index.php/TJU/article/view/138410
Section
Original article

References

1 Hall MC, Womack S, Sagalowsky AI, Carmody T, Erickstad MD, Roehrborn CG. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients. Urology. 1998; 52(4):594–601.
2 Raman JD, Messer J, Sielatycki JA, Hollenbeak CS. Incidence and survival of patients with carcinoma of the ureter and renal pelvis in the USA, 1973–2005. BJU Int. 2011; 107(7):1059–64.
3 Brown GA, Busby JE, Wood CG, Pisters LL, Dinney CP, Swanson DA, et al. Nephroureterectomy for treating upper urinary tract transitional cell carcinoma: Time to change the treatment paradigm? BJU Int. 2006; 98(6):1176–80.
4 Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E, et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 2009; 115(6):1224–33.
5 Munoz JJ, Ellison LM. Upper tract urothelial neoplasms: incidence and survival during the last 2 decades. J Urol. 2000; 164(5):1523–5.
6 Lughezzani G, Jeldres C, Isbarn H, Sun M, Shariat SF, Alasker A, et al. Nephroureterectomy and segmental ureterectomy in the treatment of invasive upper tract urothelial carcinoma: a population- based study of 2299 patients. Eur J Cancer. 2009; 45(18):3291–7.
7 Millikan R, Dinney C, Swanson D, Sweeney P, Ro JY, Smith TL, et al. Integrated therapy for locally advanced bladder cancer: final report of a randomized trial of cystectomy plus adjuvant M- VAC versus cystectomy with both preoperative and postoperative M-VAC. J Clin Oncol. 2001; 19(20):4005–13.
8 Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta- analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration. Eur Urol. 2005; 48(2):202–5. discussion 05-6.
9 Kaag MG, O’Malley RL, O’Malley P, Godoy G, Chen M, Smaldone MC, et al. Changes in renal function following nephroureterectomy may affect the use of perioperative chemotherapy. Eur Urol. 2010; 58(4):581–7.
10 Matin SF, Margulis V, Kamat A, Wood CG, Grossman HB, Brown GA, et al. Incidence of downstaging and complete remission after neoadjuvant chemotherapy for high-risk upper tract transitional cell carcinoma. Cancer. 2010; 116(13):3127–34.
11 Igawa M, Urakami S, Shiina H, Kishi H, Himeno Y, Ishibe T, et al. Neoadjuvant chemotherapy for locally advanced urothelial cancer of the upper urinary tract. Urol Int. 1995; 55(2):74–7.
12 Fritsche, HM.; Novara, G.; Burger, M.; Gupta, A.; Matsumoto, K.; Kassouf, W., et al. Macroscopic sessile tumor architecture is a pathologic feature of biologically aggressive upper tract urothelial carcinoma. Urol Oncol. 2010.
13 Keeley FX, Kulp DA, Bibbo M, McCue PA, Bagley DH. Diagnostic accuracy of ureteroscopic biopsy in upper tract transitional cell carcinoma. J Urol. 1997; 157(1):33–7.
14 Cho KS, Hong SJ, Cho NH, Choi YD. Grade of hydronephrosis and tumor diameter as preoperative prognostic factors in ureteral transitional cell carcinoma. Urology. 2007; 70(4):662– 6.
15 Simone G, Papalia R, Loreto A, Leonardo C, Sentinelli S, Gallucci M. Independent prognostic value of tumour diameter and tumour necrosis in upper urinary tract urothelial carcinoma. BJU Int. 2009; 103(8):1052–7.
16 Fritsche, HM.; Novara, G.; Burger, M.; Gupta, A.; Matsumoto, K.; Kassouf, W., et al. Macroscopic sessile tumor architecture is a pathologic feature of biologically aggressive upper tract urothelial carcinoma. Urol Oncol. 2010.
17 Kwak C, Lee SE, Jeong IG, Ku JH. Adjuvant systemic chemotherapy in the treatment of patients with invasive transitional cell carcinoma of the upper urinary tract. Urology. 2006; 68(1):53–7.
18 Lee SE, Byun SS, Park YH, Chang IH, Kim YJ, Hong SK. Adjuvant chemotherapy in the management of pT3N0M0 transitional cell carcinoma of the upper urinary tract. Urol Int. 2006; 77(1):22–6.
19 Soga N, Arima K, Sugimura Y. Adjuvant methotrexate, vinblastine, adriamycin, and cisplatin chemotherapy has potential to prevent recurrence of bladder tumors after surgical removal of upper urinary tract transitional cell carcinoma. Int J Urol. 2008; 15(9):800–3.
20 Hellenthal NJ, Shariat SF, Margulis V, Karakiewicz PI, Roscigno M, Bolenz C, et al. Adjuvant chemotherapy for high risk upper tract urothelial carcinoma: results from the Upper Tract Urothelial Carcinoma Collaboration. J Urol. 2009; 182(3):900–6.
21 Vassilakopoulou, M.; de la Motte Rouge, T.; Colin, P.; Ouzzane, A.; Khayat, D.; Dimopoulos, MA., et al. Outcomes after adjuvant chemotherapy in the treatment of high-risk urothelial carcinoma of the upper urinary tract (UUT-UC): Results From a Large Multicenter Collaborative Study. Cancer. 2011.
22 Bamias A, Deliveliotis C, Fountzilas G, Gika D, Anagnostopoulos A, Zorzou MP, et al. Adjuvant chemotherapy with paclitaxel and carboplatin in patients with advanced carcinoma of the upper urinary tract: a study by the Hellenic Cooperative Oncology Group. J Clin Oncol. 2004; 22(11): 2150–4.
23 Eylert MF, Hounsome L, Verne J, Bahl A, Jefferies ER, Persad RA. Prognosis is deteriorating for upper tract urothelial cancer: data for England 1985–2010. BJU Int. 2012; 112(2):E107–13.