nach oben

Erschienen in:

10.04.2017 | Original Article

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

verfasst von: Tohru Nakagawa, Yoshimitsu Komemushi, Taketo Kawai, Masafumi Otsuka, Jimpei Miyakawa, Yukari Uemura, Atsushi Kanatani, Satoru Taguchi, Akihiro Naito, Motofumi Suzuki, Hiroaki Nishimatsu, Yoshikazu Hirano, Yoshinori Tanaka, Akihiko Matsumoto, Hideyo Miyazaki, Tetsuya Fujimura, Hiroshi Fukuhara, Haruki Kume, Yasuhiko Igawa, Yukio Homma

Erschienen in: World Journal of Urology | Ausgabe 10/2017

Einloggen, um Zugang zu erhalten

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.

Nur mit Berechtigung zugänglich

Rouprêt M, Babjuk M, Compérat E, Zigeuner R, Sylvester RJ, Burger M, Cowan NC, Böhle A, Van Rhijn BW, Kaasinen E, Palou J, Shariat SF (2015) European association of urology guidelines on upper urinary tract urothelial cell carcinoma: 2015 update. Eur Urol 68:868–879. doi:10.1016/j.eururo.2015.06.044 CrossRefPubMed

Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E, Lotan Y, Weizer A, Raman JD, Wood CG, The Upper Tract Urothelial Carcinoma Collaboration (2009) Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer 115:1224–1233. doi:10.1002/cncr.24135 CrossRefPubMed

Matsumoto K, Novara G, Gupta A, Margulis V, Walton TJ, Roscigno M, Ng C, Kikuchi E, Zigeuner R, Kassouf W, Fritsche HM, Ficarra V, Martignoni G, Tritschler S, Rodriguez JC, Seitz C, Weizer A, Remzi M, Raman JD, Bolenz C, Bensalah K, Koppie TM, Karakiewicz PI, Wood CG, Montorsi F, Iwamura M, Shariat SF (2011) Racial differences in the outcome of patients with urothelial carcinoma of the upper urinary tract: an international study. BJU Int 108:E304–E309. doi:10.1111/j.1464-410X.2011.10188.x CrossRefPubMed

Ploussard G, Xylinas E, Lotan Y, Novara G, Margulis V, Rouprêt M, Matsumoto K, Karakiewicz PI, Montorsi F, Remzi M, Seitz C, Scherr DS, Kapoor A, Fairey AS, Rendon R, Izawa J, Black PC, Lacombe L, Shariat SF, Kassouf W (2015) Conditional survival after radical nephroureterectomy for upper tract carcinoma. Eur Urol 67:803–812. doi:10.1016/j.eururo.2014.08.003 CrossRefPubMed

Bamias A, Deliveliotis CH, Fountzilas G, Gika D, Anagnostopoulos A, Zorzou MP, Kastritis E, Constantinides C, Kosmidis P, Dimopoulos MA (2004) 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 22:2150–2154CrossRefPubMed

Hellenthal NJ, Shariat SF, Margulis V, Karakiewicz PI, Roscigno M, Bolenz C, Remzi M, Weizer A, Zigeuner R, Bensalah K, Ng CK, Raman JD, Kikuchi E, Montorsi F, Oya M, Wood CG, Fernandez M, Evans CP, Koppie TM (2009) Adjuvant chemotherapy for high risk upper tract urothelial carcinoma: results from the Upper Tract Urothelial Carcinoma Collaboration. J Urol 182:900–906. doi:10.1016/j.juro.2009.05.011 CrossRefPubMed

Vassilakopoulou M, de la Motte Rouge T, Colin P, Ouzzane A, Khayat D, Dimopoulos MA, Papadimitriou CA, Bamias A, Pignot G, Nouhaud FX, Hurel S, Guy L, Bigot P, Roumiguié M, Rouprêt M, French Collaborative National Database on UUT-UCC (2011) 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 117:5500–5508. doi:10.1002/cncr.26172 CrossRefPubMed

Kawashima A, Nakai Y, Nakayama M, Ujike T, Tanigawa G, Ono Y, Kamoto A, Takada T, Yamaguchi Y, Takayama H, Nishimura K, Nonomura N, Tsujimura A (2012) The result of adjuvant chemotherapy for localized pT3 upper urinary tract carcinoma in a multi-institutional study. World J Urol 30:701–706. doi:10.1007/s00345-011-0775-z CrossRefPubMed

Yafi FA, Tanguay S, Rendon R, Jacobsen N, Fairey A, Izawa J, Kapoor A, Black P, Lacombe L, Chin J, So A, Lattouf JB, Bell D, Fradet Y, Saad F, Matsumoto E, Drachenberg D, Cagiannos I, Kassouf W (2014) Adjuvant chemotherapy for upper-tract urothelial carcinoma treated with nephroureterectomy: assessment of adequate renal function and influence on outcome. Urol Oncol 32:31.e17–24. doi: 10.1016/j.urolonc.2012.11.014

10.

Leow JJ, Martin-Doyle W, Fay AP, Choueiri TK, Chang SL, Bellmunt J (2014) A systematic review and meta-analysis of adjuvant and neoadjuvant chemotherapy for upper tract urothelial carcinoma. Eur Urol 66:529–541. doi:10.1016/j.eururo.2014.03.003 CrossRefPubMed

11.

Huang YC, Chen MF, Shi CS, Shindel AW, Huang CE, Pang ST, Chuang CK, Chen CS, Chang YH, Lin WY, Ho DR, Chin CC, Kuo YH, Wu CF (2015) The efficacy of postoperative adjuvant chemotherapy for patients with pT3N0M0 upper tract urothelial carcinoma. J Urol 194:323–329. doi:10.1016/j.juro.2015.03.077 CrossRefPubMed

12.

Kim HS, Lee JS, Jeong CW, Kwak C, Kim HH, Ku JH (2015) Adjuvant chemotherapy for locally advanced upper tract urothelial carcinoma: updated results of the Seoul National University Hospital experience. Int Braz J Urol 41:1067–1079. doi:10.1590/S1677-5538.IBJU.2015.0009 CrossRefPubMedPubMedCentral

13.

Seisen T, Krasnow RE, Bellmunt J, Rouprêt M, Leow JJ, Lipsitz SR, Vetterlein MW, Preston MA, Hanna N, Kibel AS, Sun M, Choueiri TK, Trinh QD, Chang SL (2017) Effectiveness of adjuvant chemotherapy after radical nephroureterectomy for locally advanced and/or positive regional lymph node upper tract urothelial carcinoma. J Clin Oncol 35:852–860. doi:10.1200/JCO.2016.69.4141

14.

Aziz A, Dobruch J, Hendricksen K, Kluth LA, Necchi A, Noon A, Rink M, Roghmann F, Seiler R, Gontero P, Kassouf W, Shariat SF, Xylinas E, Young Academic Urologists Urothelial Carcinoma Group of the European Association of Urology (2017) Perioperative chemotherapy in upper tract urothelial carcinoma: a comprehensive review. World J Urol. doi:10.1007/s00345-016-1995-z

15.

Eble J, Sauter G, Epstein J (2004) World Health Organization classification of tumours. In: Kleihues P, Sobin LH (eds) Pathology and genetics of tumours of the urinary system and male genital organs, vol 7. IARC Press, Lyon

16.

Sobin LH, Gospodarowicz MK, Wittekind CH (2009) TNM Classification of Malignant Tumors, 7th edn. Union Internationale Contre le Cancer and the American Joint Committee on Cancer

17.

Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A, Collaborators developing the Japanese equation for estimated GFR (2009) Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 53:982–992. doi:10.1053/j.ajkd.2008.12.034 CrossRefPubMed

18.

Kakutani S, Fukuhara H, Taguchi S, Nagata M, Niimi A, Hattori M, Miyazaki H, Fujimura T, Nakagawa T, Kume H, Igawa Y, Homma Y (2015) Combination of docetaxel, ifosfamide and cisplatin (DIP) as a potential salvage chemotherapy for metastatic urothelial carcinoma. Jpn J Clin Oncol 45:281–285. doi:10.1093/jjco/hyu201 CrossRefPubMed

19.

Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, deVere White RW, Sarosdy MF, Wood DP Jr, Raghavan D, Crawford ED (2003) Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 349:859–866CrossRefPubMed

20.

International Collaboration of Trialists, Medical Research Council Advanced Bladder Cancer Working Party (now the National Cancer Research Institute Bladder Cancer Clinical Studies Group), European Organisation for Research and Treatment of Cancer Genito-Urinary Tract Cancer Group, Australian Bladder Cancer Study Group, National Cancer Institute of Canada Clinical Trials Group, Finnbladder, Norwegian Bladder Cancer Study Group, Club Urologico Espanol de Tratamiento Oncologico Group, Griffiths G, Hall R, Sylvester R, Raghavan D, Parmar MK (2011) International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: long-term results of the BA06 30894 trial. J Clin Oncol 29:2171–2177. doi:10.1200/JCO.2010.32.3139 CrossRefPubMedCentral

21.

Porten S, Siefker-Radtke AO, Xiao L, Margulis V, Kamat AM, Wood CG, Jonasch E, Dinney CP, Matin SF (2014) Neoadjuvant chemotherapy improves survival of patients with upper tract urothelial carcinoma. Cancer 120:1794–1799. doi:10.1002/cncr.28655 CrossRefPubMedPubMedCentral

22.

Kaag MG, O’Malley RL, O’Malley P, Godoy G, Chen M, Smaldone MC, Hrebinko RL, Raman JD, Bochner B, Dalbagni G, Stifelman MD, Taneja SS, Huang WC (2010) Changes in renal function following nephroureterectomy may affect the use of perioperative chemotherapy. Eur Urol 58:581–587. doi:10.1016/j.eururo.2010.06.029 CrossRefPubMedPubMedCentral

23.

Morales-Barrera R, Suárez C, de Castro AM, Racca F, Valverde C, Maldonado X, Bastaros JM, Morote J, Carles J (2016) Targeting fibroblast growth factor receptors and immune checkpoint inhibitors for the treatment of advanced bladder cancer: new direction and New Hope. Cancer Treat Rev. doi:10.1016/j.ctrv.2016.09.018 PubMed

Titel: Efficacy of post-nephroureterectomy cisplatin-based adjuvant chemotherapy for locally advanced upper tract urothelial carcinoma: a multi-institutional retrospective study
verfasst von: Tohru Nakagawa
Yoshimitsu Komemushi
Taketo Kawai
Masafumi Otsuka
Jimpei Miyakawa
Yukari Uemura
Atsushi Kanatani
Satoru Taguchi
Akihiro Naito
Motofumi Suzuki
Hiroaki Nishimatsu
Yoshikazu Hirano
Yoshinori Tanaka
Akihiko Matsumoto
Hideyo Miyazaki
Tetsuya Fujimura
Hiroshi Fukuhara
Haruki Kume
Yasuhiko Igawa
Yukio Homma
Publikationsdatum: 10.04.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 10/2017
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-017-2032-6

Neu im Fachgebiet Urologie

Adjuvante Immuntherapie verlängert Leben bei RCC

25.04.2024 Nierenkarzinom Nachrichten

Nun gibt es auch Resultate zum Gesamtüberleben: Eine adjuvante Pembrolizumab-Therapie konnte in einer Phase-3-Studie das Leben von Menschen mit Nierenzellkarzinom deutlich verlängern. Die Sterberate war im Vergleich zu Placebo um 38% geringer.

Bei Senioren mit Prostatakarzinom auf Anämie achten!

24.04.2024 DGIM 2024 Nachrichten

Patienten, die zur Behandlung ihres Prostatakarzinoms eine Androgendeprivationstherapie erhalten, entwickeln nicht selten eine Anämie. Wer ältere Patienten internistisch mitbetreut, sollte auf diese Nebenwirkung achten.

Stufenschema weist Prostatakarzinom zuverlässig nach

22.04.2024 Prostatakarzinom Nachrichten

Erst PSA-Test, dann Kallikrein-Score, schließlich MRT und Biopsie – ein vierstufiges Screening-Schema kann die Zahl der unnötigen Prostatabiopsien erheblich reduzieren: Die Hälfte der Männer, die in einer finnischen Studie eine Biopsie benötigten, hatte einen hochgradigen Tumor.

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

20.04.2024 EAU 2024 Kongressbericht

Beim chronischen Harnwegsinfekt bei Frauen wird bisher meist eine Antibiotikaprophylaxe eingesetzt. Angesichts der zunehmenden Antibiotikaresistenz erweist sich das Antiseptikum Methenamin-Hippurat als vielversprechende Alternative, so die Auswertung einer randomisierten kontrollierten Studie.

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Materials and methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 10/2017

Development of novel nomograms to predict renal functional outcomes after laparoscopic adrenalectomy in patients with primary aldosteronism

The changes of urethral morphology recognized in voiding cystourethrography after endoscopic transurethral incision for posterior urethral valve in boys with intractable daytime urinary incontinence and nocturnal enuresis

The effect of a cyclic uniaxial strain on urinary bladder cells

Multicenter international experience of 532 nm-laser photo-vaporization with Greenlight XPS in men with large prostates (prostate volume > 100 cc)

Five-year outcomes of thulium vapoenucleation of the prostate for symptomatic benign prostatic obstruction