Korean J Urol.  2015 Jan;56(1):41-47. 10.4111/kju.2015.56.1.41.

Impact of adjuvant chemotherapy in patients with upper tract urothelial carcinoma and lymphovascular invasion after radical nephroureterectomy

• Lee KS
• Kim KH
• Yoon YE
• Choi KH
• Yang SC
• Han WK

• KMID: 2070267
• DOI: http://doi.org/10.4111/kju.2015.56.1.41

Abstract

PURPOSE
To evaluate the impact of adjuvant chemotherapy (AC) in patients with upper tract urothelial carcinoma and lymphovascular invasion (LVI) after radical nephroureterectomy (RNU).
MATERIALS AND METHODS
We retrospectively analyzed the clinical records and clinicopatholgic outcomes of patients (n=552) treated with RNU between 1986 and 2013. Patients treated with neoadjuvant chemotherapy and those for whom LVI status was not recorded were excluded. Patients were divided into two groups according to LVI (n=86) or no LVI (n=256).
RESULTS
The study included 344 patients (240 men and 104 women) with a median of 53.9 months of follow-up (range, 1-297 months) after RNU. Tumors were organ confined (T2/N0) in 211 (61.3%) and tumor grade high in 291 (84.6%). AC was administered in 64 patients (18.6%). A total of 280 patients (81.4%) were treated with surgery alone. Patients with LVI tended to be older (p=0.049), have a higher pT stage (pT3/T4, p<0.001), be pN+ (p<0.001), have a high tumor grade (p<0.001), and experience recurrence (p<0.001). In the multivariate analysis, LVI was an independent prognostic factor for cancer-specific survival and overall survival (p=0.002 and p<0.001, respectively). The multivariate analysis demonstrated that in the subgroup of patients with LVI, AC was a significant prognostic factor for cancer-specific survival and overall survival (hazard ratio, 0.51; p=0.027 and hazard ratio, 0.50; p=0.025, respectively).
CONCLUSIONS
AC does not seem to reduce mortality in patients with advanced upper tract urothelial carcinoma after RNU. In the subgroup of patients with LVI, AC had a positive impact on cancer-specific survival and overall survival. LVI would be helpful for selecting patients who are appropriate for AC.

Keyword

Adjuvant chemotherapy; Kidney pelvis; Transitional cell carcinoma; Ureter; Urinary tract

MeSH Terms

Aged
Carcinoma, Transitional Cell/drug therapy/*mortality/surgery
*Chemotherapy, Adjuvant
Female
Follow-Up Studies
Humans
Kidney Neoplasms/drug therapy/*mortality/surgery
Lymphatic Metastasis
Male
Middle Aged
Multivariate Analysis
Neoplasm Grading
Neoplasm Recurrence, Local
Neoplasm Staging
Nephrectomy
Prognosis
Retrospective Studies
Survival Rate
Ureter/pathology
Ureteral Neoplasms/drug therapy/*mortality/surgery
Urinary Tract/pathology

Figure

• 

  Fig. 1 Impact of lymphovascular invasion (LVI) in cancer-specific (A) and overall survivals (B) in patients with upper urinary tract transitional cell carcinoma.

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