Impact of an adjuvant chemotherapeutic regimen on the clinical outcome in high risk patients with upper tract urothelial carcinoma

A Japanese multi-institution experience

Suguru Shirotake, Eiji Kikuchi, Nobuyuki Tanaka, Kazuhiro Matsumoto, Yasumasa Miyazaki, Hiroaki Kobayashi, Hiroki Ide, Jun Obata, Katsura Hoshino, Gou Kaneko, Masayuki Hagiwara, Takeo Kosaka, Kent Kanao, Kiichiro Kodaira, Satoshi Hara, Masafumi Oyama, Tetsuo Momma, Akira Miyajima, Ken Nakagawa, Shintaro Hasegawa & 2 others Yosuke Nakajima, Mototsugu Oya

Research output: Contribution to journalArticle

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Abstract

Purpose Current guidelines do not yet provide any recommendations for adjuvant chemotherapy in patients with upper tract urothelial carcinoma managed with radical nephroureterectomy. We evaluated whether an adjuvant chemotherapeutic regimen would affect the clinical outcome in patients with high risk upper tract urothelial carcinoma. Materials and Methods We identified 873 patients who had undergone radical nephrouretectomy for localized upper tract urothelial carcinoma at 14 Japanese institutions between 1993 and 2011. We assessed whether the type of regimen, such as methotrexate, vinblastine, doxorubicin and cisplatin, and gemcitabine and cisplatin, in an adjuvant setting, could affect the subsequent clinical outcome of patients with upper tract urothelial carcinoma. Results On multivariate analysis pathological T stage, tumor grade, lymphovascular invasion and lymph node involvement were prognostic factors for recurrence-free survival and cancer specific survival. We defined 229 patients with 3 or more of these factors as the high risk group. In an analysis according to adjuvant regimen, Kaplan-Meier curves showed that the 1 and 2-year recurrence-free survival rates in the methotrexate, vinblastine, doxorubicin and cisplatin treated group were 71.4% and 47.9%, which were significantly higher than in the gemcitabine and cisplatin treated group (48.2% and not reached, p=0.022) or those not treated with adjuvant chemotherapy (53.4% and 39.6%, p=0.039). Similar results were observed in terms of cancer specific survival. Conclusions Our study showed that pT3-4, tumor grade 3, positive lymphovascular invasion and lymph node involvement were independent risk factors for disease mortality in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy. In the high risk group methotrexate, vinblastine, doxorubicin and cisplatin adjuvant chemotherapy contributed to improve subsequent mortality compared to gemcitabine and cisplatin or no adjuvant chemotherapy.

Original languageEnglish
Pages (from-to)1122-1128
Number of pages7
JournalJournal of Urology
Volume193
Issue number4
DOIs
Publication statusPublished - 2015 Apr 1

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gemcitabine
Cisplatin
Adjuvant Chemotherapy
Carcinoma
Vinblastine
Methotrexate
Doxorubicin
Survival
Neoplasms
Lymph Nodes
Recurrence
Mortality
Multivariate Analysis
Survival Rate
Guidelines

Keywords

  • adjuvant
  • carcinoma
  • chemotherapy
  • transitional cell
  • treatment outcome
  • urinary tract

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

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Impact of an adjuvant chemotherapeutic regimen on the clinical outcome in high risk patients with upper tract urothelial carcinoma : A Japanese multi-institution experience. / Shirotake, Suguru; Kikuchi, Eiji; Tanaka, Nobuyuki; Matsumoto, Kazuhiro; Miyazaki, Yasumasa; Kobayashi, Hiroaki; Ide, Hiroki; Obata, Jun; Hoshino, Katsura; Kaneko, Gou; Hagiwara, Masayuki; Kosaka, Takeo; Kanao, Kent; Kodaira, Kiichiro; Hara, Satoshi; Oyama, Masafumi; Momma, Tetsuo; Miyajima, Akira; Nakagawa, Ken; Hasegawa, Shintaro; Nakajima, Yosuke; Oya, Mototsugu.

In: Journal of Urology, Vol. 193, No. 4, 01.04.2015, p. 1122-1128.

Research output: Contribution to journalArticle

Shirotake, S, Kikuchi, E, Tanaka, N, Matsumoto, K, Miyazaki, Y, Kobayashi, H, Ide, H, Obata, J, Hoshino, K, Kaneko, G, Hagiwara, M, Kosaka, T, Kanao, K, Kodaira, K, Hara, S, Oyama, M, Momma, T, Miyajima, A, Nakagawa, K, Hasegawa, S, Nakajima, Y & Oya, M 2015, 'Impact of an adjuvant chemotherapeutic regimen on the clinical outcome in high risk patients with upper tract urothelial carcinoma: A Japanese multi-institution experience', Journal of Urology, vol. 193, no. 4, pp. 1122-1128. https://doi.org/10.1016/j.juro.2014.10.022
Shirotake, Suguru ; Kikuchi, Eiji ; Tanaka, Nobuyuki ; Matsumoto, Kazuhiro ; Miyazaki, Yasumasa ; Kobayashi, Hiroaki ; Ide, Hiroki ; Obata, Jun ; Hoshino, Katsura ; Kaneko, Gou ; Hagiwara, Masayuki ; Kosaka, Takeo ; Kanao, Kent ; Kodaira, Kiichiro ; Hara, Satoshi ; Oyama, Masafumi ; Momma, Tetsuo ; Miyajima, Akira ; Nakagawa, Ken ; Hasegawa, Shintaro ; Nakajima, Yosuke ; Oya, Mototsugu. / Impact of an adjuvant chemotherapeutic regimen on the clinical outcome in high risk patients with upper tract urothelial carcinoma : A Japanese multi-institution experience. In: Journal of Urology. 2015 ; Vol. 193, No. 4. pp. 1122-1128.
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T1 - Impact of an adjuvant chemotherapeutic regimen on the clinical outcome in high risk patients with upper tract urothelial carcinoma

T2 - A Japanese multi-institution experience

AU - Shirotake, Suguru

AU - Kikuchi, Eiji

AU - Tanaka, Nobuyuki

AU - Matsumoto, Kazuhiro

AU - Miyazaki, Yasumasa

AU - Kobayashi, Hiroaki

AU - Ide, Hiroki

AU - Obata, Jun

AU - Hoshino, Katsura

AU - Kaneko, Gou

AU - Hagiwara, Masayuki

AU - Kosaka, Takeo

AU - Kanao, Kent

AU - Kodaira, Kiichiro

AU - Hara, Satoshi

AU - Oyama, Masafumi

AU - Momma, Tetsuo

AU - Miyajima, Akira

AU - Nakagawa, Ken

AU - Hasegawa, Shintaro

AU - Nakajima, Yosuke

AU - Oya, Mototsugu

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Purpose Current guidelines do not yet provide any recommendations for adjuvant chemotherapy in patients with upper tract urothelial carcinoma managed with radical nephroureterectomy. We evaluated whether an adjuvant chemotherapeutic regimen would affect the clinical outcome in patients with high risk upper tract urothelial carcinoma. Materials and Methods We identified 873 patients who had undergone radical nephrouretectomy for localized upper tract urothelial carcinoma at 14 Japanese institutions between 1993 and 2011. We assessed whether the type of regimen, such as methotrexate, vinblastine, doxorubicin and cisplatin, and gemcitabine and cisplatin, in an adjuvant setting, could affect the subsequent clinical outcome of patients with upper tract urothelial carcinoma. Results On multivariate analysis pathological T stage, tumor grade, lymphovascular invasion and lymph node involvement were prognostic factors for recurrence-free survival and cancer specific survival. We defined 229 patients with 3 or more of these factors as the high risk group. In an analysis according to adjuvant regimen, Kaplan-Meier curves showed that the 1 and 2-year recurrence-free survival rates in the methotrexate, vinblastine, doxorubicin and cisplatin treated group were 71.4% and 47.9%, which were significantly higher than in the gemcitabine and cisplatin treated group (48.2% and not reached, p=0.022) or those not treated with adjuvant chemotherapy (53.4% and 39.6%, p=0.039). Similar results were observed in terms of cancer specific survival. Conclusions Our study showed that pT3-4, tumor grade 3, positive lymphovascular invasion and lymph node involvement were independent risk factors for disease mortality in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy. In the high risk group methotrexate, vinblastine, doxorubicin and cisplatin adjuvant chemotherapy contributed to improve subsequent mortality compared to gemcitabine and cisplatin or no adjuvant chemotherapy.

AB - Purpose Current guidelines do not yet provide any recommendations for adjuvant chemotherapy in patients with upper tract urothelial carcinoma managed with radical nephroureterectomy. We evaluated whether an adjuvant chemotherapeutic regimen would affect the clinical outcome in patients with high risk upper tract urothelial carcinoma. Materials and Methods We identified 873 patients who had undergone radical nephrouretectomy for localized upper tract urothelial carcinoma at 14 Japanese institutions between 1993 and 2011. We assessed whether the type of regimen, such as methotrexate, vinblastine, doxorubicin and cisplatin, and gemcitabine and cisplatin, in an adjuvant setting, could affect the subsequent clinical outcome of patients with upper tract urothelial carcinoma. Results On multivariate analysis pathological T stage, tumor grade, lymphovascular invasion and lymph node involvement were prognostic factors for recurrence-free survival and cancer specific survival. We defined 229 patients with 3 or more of these factors as the high risk group. In an analysis according to adjuvant regimen, Kaplan-Meier curves showed that the 1 and 2-year recurrence-free survival rates in the methotrexate, vinblastine, doxorubicin and cisplatin treated group were 71.4% and 47.9%, which were significantly higher than in the gemcitabine and cisplatin treated group (48.2% and not reached, p=0.022) or those not treated with adjuvant chemotherapy (53.4% and 39.6%, p=0.039). Similar results were observed in terms of cancer specific survival. Conclusions Our study showed that pT3-4, tumor grade 3, positive lymphovascular invasion and lymph node involvement were independent risk factors for disease mortality in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy. In the high risk group methotrexate, vinblastine, doxorubicin and cisplatin adjuvant chemotherapy contributed to improve subsequent mortality compared to gemcitabine and cisplatin or no adjuvant chemotherapy.

KW - adjuvant

KW - carcinoma

KW - chemotherapy

KW - transitional cell

KW - treatment outcome

KW - urinary tract

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