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Adjuvant chemotherapy following radical nephroureterectomy for upper tract urothelial carcinoma - Beyond the Abstract

Upper tract urothelial carcinoma is an uncommon disease. The standard of care for these tumors is radical nephroureterectomy with bladder cuff removal. Data specifically addressing the impact of adjuvant chemotherapy for patients with upper tract has been lacking.

A recent study by Seisen et al. published in the Journal of Clinical Oncology, examined the National Cancer Database records from 2004 to 2012 to identify patients with locally advanced or node-positive upper tract urothelial carcinoma following nephrouretrectomy. The investigators compared the outcomes for patients who received adjuvant chemotherapy to those who were only observed. The study identified 3,253 individuals who received either adjuvant chemotherapy or observation after radical nephrouretrectomy for pT3/T4 and/or pN+ upper tract urothelial carcinoma. The adjusted median overall survival was significantly longer for patients receiving adjuvant chemotherapy compared to observation (47.41 [interquartile range, 19.88 to 112.39] v 35.78 [interquartile range, 14.09 to 99.22] months; P < .001). Cox proportional hazards regression analysis confirmed that adjuvant chemotherapy was associated with a significant overall benefit (hazard ratio, 0.77 [95% CI, 0.68 to 0.88]; P<.001) in for upper-tract urothelial carcinoma patients. Moreover, the treatment benefit was consistent across all subgroups.

This important study provides data supporting the efficacy of adjuvant chemotherapy specific to the upper tract urothelial carcinoma stetting. The authors correctly point out the limitations inherent to retrospective observational studies but make the case that adjuvant chemotherapy should be considered in patients with pT3/T4 and/or pN+ upper tract urothelial carcinoma pending level I evidence.

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Author: Bishoy M. Faltas MD

Reference:

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. Effectiveness of Adjuvant Chemotherapy After Radical Nephroureterectomy for Locally Advanced and/or Positive Regional Lymph Node Upper Tract Urothelial Carcinoma. J Clin Oncol. 2017 Jan 3:JCO2016694141. [Epub ahead of print]