Effect of preoperative chemotherapy on survival of patients with upper urinary tract urothelial carcinoma clinically involving regional lymph nodes

• Published in: International journal of urology Vol. 23; no. 2; pp. 153 - 158
• Main Authors: Kobayashi, Kazuhiro, Saito, Toshihiro, Kitamura, Yasuo, Bilim, Vladimir, Toba, Tomotaka, Kawasaki, Takashi, Hara, Noboru, Tanikawa, Toshiki, Tomita, Yoshihiko
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.02.2016
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma, Transitional Cell - drug therapy; Carcinoma, Transitional Cell - surgery; chemotherapy; Humans; lymph node metastasis; Lymph Nodes; Lymphatic Metastasis; neoadjuvant; Nephrectomy; nephroureterectomy; Retrospective Studies; upper urinary tract urothelial carcinoma; Ureteral Neoplasms - drug therapy; Ureteral Neoplasms - surgery; Urinary Tract; neoadjuvant; upper urinary tract urothelial carcinoma; nephroureterectomy; chemotherapy; lymph node metastasis
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/iju.13010

Objectives To determine the effect of preoperative chemotherapy on survival in patients with upper urinary tract urothelial carcinoma clinically involving regional lymph nodes. Methods We retrospectively analyzed 55 consecutive patients who received radical nephroureterectomy with or without preoperative chemotherapy for upper urinary tract urothelial carcinoma clinically involving regional lymph nodes at a single institution between January 1991 and December 2013. Results Median follow up was 18 months (range 2–193). Of 55 patients, 24 (43.6%) received preoperative chemotherapy (study group) and 31 (56.4%) underwent primary surgery (control group). Preoperative chemotherapy consisted of two to four cycles (median 3) of cisplatin‐containing regimens. The fraction of patients with lower pathological T stage and N stage than clinical T stage and N stage was higher in the study group (29.2% and 54.2%) compared with the control group (3.2% and 16.1%; P = 0.013 and 0.010, respectively). The 5‐year overall survival rate was significantly higher in the study group than in the control group (44.0% vs 12.9%, log–rank, P = 0.003). In multivariate analysis incorporating age at diagnosis, Eastern Cooperative Oncology Group Performance Status, clinical N stage and the number of removed lymph nodes, preoperative chemotherapy was a predictor of better overall survival (P = 0.047, HR 0.47, 95% CI 0.22–0.99). Conclusions Preoperative chemotherapy might provide better survival outcomes in patients with upper urinary tract urothelial carcinoma clinically involving regional lymph nodes.