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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
Article first published online: 2 JUN 2011
Copyright © 2011 American Cancer Society
Volume 117, Issue 24, pages 5500–5508, 15 December 2011
How to Cite
Vassilakopoulou, M., de la Motte Rouge, T., Colin, P., Ouzzane, A., Khayat, D., Dimopoulos, M.-A., Papadimitriou, C. A., Bamias, A., Pignot, G., Nouhaud, F. X., Hurel, S., Guy, L., Bigot, P., Roumiguié, M., Rouprêt, M. and for the French collaborative national database on UUT-UCC (2011), Outcomes after adjuvant chemotherapy in the treatment of high-risk urothelial carcinoma of the upper urinary tract (UUT-UC). Cancer, 117: 5500–5508. doi: 10.1002/cncr.26172
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.
- Issue published online: 2 DEC 2011
- Article first published online: 2 JUN 2011
- Manuscript Revised: 24 FEB 2011
- Manuscript Received: 8 FEB 2011
- Manuscript Accepted: 3 MAR 2010
- urinary tract cancer;
- urothelial carcinoma;
- renal pelvis;
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.
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.
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).
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.