Erschienen in:
18.12.2019 | Urologic Oncology
Neoadjuvant Chemotherapy Benefits Survival in High-Grade Upper Tract Urothelial Carcinoma: A Propensity Score-Based Analysis
verfasst von:
Lingxiao Chen, MD, Zhenyu Ou, MD, Ruizhe Wang, MD, Mengda Zhang, MD, Wei He, MD, Junjie Zhang, MD, Xiongbing Zu, MD, Lu Yi, MD, Ran Xu, MD, Shusuan Jiang, MD, Lin Qi, MD, Long Wang, MD
Erschienen in:
Annals of Surgical Oncology
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Ausgabe 4/2020
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Abstract
Background
To evaluate the benefit of neoadjuvant chemotherapy (NAC) for survival in high-grade upper tract urothelial carcinoma (UTUC), a propensity score-based analysis was performed with high-grade UTUC patients from multiple urologic centers.
Methods
From three urologic centers, 48 high-grade UTUC patients who received chemotherapy followed by surgery (NAC group) and 72 high-grade UTUC patients who underwent initial surgery (no-NAC group) were involved in a propensity score-based analysis. After propensity score-based (1:1) matching, 37 patients receiving NAC and 37 patients not receiving NAC were followed.
Results
The patients who received NAC had improved disease-free survival (DFS) and overall survival (OS), with a 3-year DFS rate of 78.4% and an OS rate of 86.5% versus a 3-year DFS rate of 51.4% and an OS rate of 62.2% for those treated with initial surgery (P = 0.018 and P = 0.02, respectively). In the multivariate analysis, the NAC group had a lower risk for mortality [DFS hazard ratio (HR) 0.25; 95% confidence interval (CI) 0.10–0.62; P = 0.003; OS HR 0.22; 95% CI 0.085–0.57; P = 0.002]. The analysis of patient survival in matched subgroups showed that NAC was beneficial in terms of the 3-year DFS for the group with a cT of 3 or higher (DFS HR 0.37; 95% CI 0.14–0.94; P = 0.036) and the group that had tumor with hydronephrosis (DFS HR 0.31; 95% CI 0.11–0.87; P = 0.026).
Conclusion
The study showed that NAC may be considered as an effective addition to surgery for the treatment in high-grade UTUC patients.