Oncological outcomes of neoadjuvant chemotherapy in patients with locally advanced upper tract urothelial carcinoma: a multicenter study

Abstract

ObjectiveThe clinical impact of neoadjuvant chemotherapy (NAC) on oncological outcomes in patients with locally advanced upper tract urothelial carcinoma (UTUC) remains unclear. We investigated the oncological outcomes of platinum-based NAC for locally advanced UTUC.ResultsOf 234 patients, 101 received NAC (NAC group) and 133 did not (Control [Ctrl] group). The regimens in the NAC group included gemcitabine and carboplatin (75%), and gemcitabine and cisplatin (21%). Pathological downstagings of the primary tumor and lymphovascular invasion were significantly improved in the NAC than in the Ctrl groups. NAC for locally advanced UTUC significantly prolonged recurrence-free and cancer-specific survival. Multivariate Cox regression analysis using an inverse probability of treatment weighted (IPTW) method showed that NAC was selected as an independent predictor for prolonged recurrence-free and cancer-specific survival. However, the influence of NAC on overall survival was not statistically significant.Materials and MethodsA total of 426 patients who underwent radical nephroureterectomy at five medical centers between January 1995 and April 2017 were examined retrospectively. Of the 426 patients, 234 were treated for a high-risk disease (stages cT3–4 or locally advanced [cN+] disease) with or without NAC. NAC regimens were selected based on eligibility of cisplatin. We retrospectively evaluated post-therapy pathological downstaging, lymphovascular invasion, and prognosis stratified by NAC use. Multivariate Cox regression analysis was performed for independent factors for prognosis.ConclusionsPlatinum-based NAC for locally advanced UTUC potentially improves oncological outcomes. Further prospective studies are needed to clarify the clinical benefit of NAC for locally advanced UTUC.

Unusual presentation of upper urinary tract urothelial carcinoma in Taiwan: Direct comparison from Taiwan‐Japan UTUC Collaboration Cohort

“…Perioperative systemic therapy might be beneficial in locally advanced UTUC, but it is still a controversial issue. 6,[20][21][22] Different etiologies might be associated with different tumoral mutations, and we still do not understand whether the benefit of systemic therapy can be observed in different populations.…”

Relationship between oxidative stress and lower urinary tract symptoms: results from a community health survey in Japan

“…The cross‐sectional data collection from the Iwaki Health Promotion Project was approved by the Ethics Committee of Hirosaki University School of Medicine (authorization number, 2014–2015). The project was designed for the prevention of lifestyle‐related diseases and for the promotion of health to extend the lifespan of the residents of Hirosaki City (Iwaki District), which is situated in the northern part of Japan, in collaboration with Hirosaki University, Hirosaki City, and the Aomori Prefecture General Screening Centre . All participants provided written informed consent before enrolling in the study.…”

Sleep Disturbance Has a Higher Impact on General and Mental Quality of Life Reduction than Nocturia: Results from the Community Health Survey in Japan

“…The inverse probability of treatment weighting (IPTW)-adjusted logistic regression analysis was also performed for QOL reductions of >30%. IPTW method reweights both exposed and unexposed groups to emulate a propensity score-matched population [19][20][21][22][23][24][25][26][27]. Variables included in IPTW models for QOL decline of >30% were age, sex, BMI, smoking, DM, CVD, metabolic syndrome, and PSQI, and those for sleep disturbance were age, sex, BMI, smoking, DM, CVD, metabolic syndrome, and frequency of nocturia.…”