Introduction: Upper urinary tract urothelial carcinoma is uncommon. In patients with locally advanced disease or lymph node metastasis, total nephroureterectomy alone is not curative, and recurrence and metastasis will occur. Recently, evidence for adjuvant chemotherapy for upper urinary tract urothelial cancer has been presented. This study investigated the effects of adjuvant chemotherapy for upper urinary tract urothelial carcinoma for Japanese patients in real world in multicenter.
Methods: We included patients who were diagnosed with upper urinary tract epithelial cancer and underwent total nephroureterectomy at our hospital and affiliated hospitals from January 2010 to September 2020. Patients with pT3 or higher or lymph node metastasis were compared with adjuvant chemotherapy and observation. The regimen for postoperative chemotherapy was selected as Gemcitabine and Cisplatin or Carboplatin. Recurrence-free survival was defined as postoperative to recurrence, and Cancer-specific survival was defined as postoperative to cancer death. Statistics used cox proportional hazards to examine recurrence factors and factors related to survival.
Results: A total of 131 patients were enrolled. Sixty-one patients received adjuvant chemotherapy and 72 patients received observation. The 5-year recurrence-free rate was 71%, and the 5-year cancer specific survival was 72%. Recurrence-free survival was significantly longer in the adjuvant chemotherapy compared to observation (p=0.029). Predictors of recurrence-free survival were valiant (p=0.034, HR:2.178, 95% CI: 1.062-4.469), smoking (p=0.011, HR:1.986, 95% CI: 1.169-3.375), and adjuvant therapy (p=0.031, HR:0.743, 95% CI: 0.567-0.974) in multivariate analysis. Cancer specific survival was significantly longer in the adjuvant chemotherapy compared to observation (p=0.026). Predictor of cancer specific survival were adjuvant therapy (p=0.031, HR:0.715, 95% CI: 0.528-0.969) in multivariate analysis.
Conclusions: Adjuvant chemotherapy decreased recurrence and increased cancer-specific survival in real world. Adjuvant therapy may be of benefit to patients with upper urinary tract urothelial carcinoma.
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