Outcomes after adjuvant chemotherapy in the treatment of high-risk urothelial carcinoma of the upper urinary tract (UUT-UC)

Results from a large multicenter collaborative study

Authors

  • Maria Vassilakopoulou MD,

    1. Academic Department of Medical Oncology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
    2. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France
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  • Thibault de la Motte Rouge MD,

    1. Academic Department of Medical Oncology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
    2. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France
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  • Pierre Colin MD,

    1. Academic Department of Urology, CHRU Lille, Université Lille Nord de France, Lille, France; and Inserm, Unité U703, Loos, France
    2. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France
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  • Adil Ouzzane MD,

    1. Academic Department of Urology, CHRU Lille, Université Lille Nord de France, Lille, France; and Inserm, Unité U703, Loos, France
    2. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France
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  • David Khayat MD, PhD,

    1. Academic Department of Medical Oncology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
    2. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France
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  • Meletios-Athanasios Dimopoulos MD,

    1. Meletios-Athanasios Dimopoulos, Department of Clinical Therapeutics, University of Athens Medical School, Athens, Hellenic Cooperative Oncology Group (HeCOG), Greece
    2. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France
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  • Christos A. Papadimitriou MD,

    1. Meletios-Athanasios Dimopoulos, Department of Clinical Therapeutics, University of Athens Medical School, Athens, Hellenic Cooperative Oncology Group (HeCOG), Greece
    2. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France
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  • Aristotle Bamias MD,

    1. Meletios-Athanasios Dimopoulos, Department of Clinical Therapeutics, University of Athens Medical School, Athens, Hellenic Cooperative Oncology Group (HeCOG), Greece
    2. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France
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  • Géraldine Pignot MD,

    1. Academic Department of Urology of Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
    2. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France
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  • François Xavier Nouhaud MD,

    1. Academic Department of Urology, CHRU Rouen, University of Rouen, Rouen, France
    2. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France
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  • Sophie Hurel MD,

    1. Academic Department of Urology, CHRU Caen, University of Caen, Caen, France
    2. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France
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  • Laurent Guy MD, PhD,

    1. Academic Department of Urology, CHRU Clermont Ferrand, University of Clermont Ferrand, Clermont Ferrand, France
    2. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France
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  • Pierre Bigot MD,

    1. Academic Department of Urology, CHRU Angers, University of Angers, Angers, France
    2. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France
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  • Mathieu Roumiguié MD,

    1. Academic Department of Urology of Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
    2. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France
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  • Morgan Rouprêt MD, PhD,

    Corresponding author
    1. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France
    2. Academic Department of Urology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
    • Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'hôpital, 75013 Paris, France
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    • Fax: (011) 33.1.42.17.71.12

  • for the French collaborative national database on UUT-UCC

    1. Academic Department of Urology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
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  • The authors thank the other collaborators from the French collaborative national database on UUT-UCC: Emilie Adam, Baptiste Albouy, Alexandre Amatte, Frederic Arroua, Marie Audouin, Marie-Dominique Azémar, Abdel-Rahmène Azouzzi, Henri Bensadoun, Franck Bruyère, Luc Cormier, Sébastien Crouzet, Jean-Nicolas Cornu, Alexandre de La Taille, Stephane Droupy, Pierre Olivier Fais, Julien Guillotreau, Laurent Guy, Nicolas Hoareau, Alain Houlgatte, Gilles Karsenty, Charles Marchand, Charlotte Maurin, Yann Neuzillet, Véronique Phé, Emmanuel Ravier, Alain Ruffion, Frederic Staerman.

Abstract

BACKGROUND:

Urothelial carcinoma of the upper urinary tract (UUT-UC) was a rare, aggressive urologic cancer with a propensity for multifocality, local recurrence, and metastasis. High-risk patients had poor outcomes. Because of the rarity of these tumors, randomized clinical trials and data regarding adjuvant chemotherapy in locally advanced tumors are currently unavailable. Our objective was to assess the effect of adjuvant chemotherapy and the impact of potential prognostic factors on survival in high-risk, postsurgical UUT-UC patients.

METHODS:

Using a multi-institutional, international retrospective database, identified were 627 patients with high risk UUT-UCs (pT3N0, pT4N0 and/or N+ and/or M+) who underwent surgical removal. Only patients who received adjuvant chemotherapy were included.

RESULTS:

Overall, 140 patients (22.6%) with a median age of 67 years were included. The median follow-up was 22.5 months. The 5-year, overall survival for the entire cohort was 43%, the 5-year recurrence-free survival was 54%, and metastasis-free survival was 53% at 5 years. Positive surgical margins were an independent prognostic factor for recurrence (P = .06), cancer-specific mortality (P = .05), and overall mortality (P = .02) of any cause. Adjuvant chemotherapy was not linked with overall or cancer-specific survival in patients with high risk disease (adjuvant chemotherapy [n = 140] vs no treatment [n = 487]) (P >.5).

CONCLUSIONS:

Adjuvant postoperative chemotherapy did not offer any significant benefit to overall survival in our population. Additional data were necessary, and studies enrolling patients at high risk in clinical trials investigating neoadjuvant chemotherapy in conjunction with chemotherapy should have been highly encouraged. Cancer 2011;. © 2011 American Cancer Society.

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