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

Authors
 Kwang Suk Lee  ;  Kwang Hyun Kim  ;  Young Eun Yoon  ;  Kyung Hwa Choi  ;  Seung Choul Yang  ;  Woong Kyu Han 
Citation
 KOREAN JOURNAL OF UROLOGY, Vol.56(1) : 41-47, 2015 
Journal Title
 KOREAN JOURNAL OF UROLOGY 
ISSN
 2005-6737 
Issue Date
2015
MeSH
Aged ; Carcinoma, Transitional Cell/drug therapy ; Carcinoma, Transitional Cell/mortality* ; Carcinoma, Transitional Cell/surgery ; Chemotherapy, Adjuvant* ; Female ; Follow-Up Studies ; Humans ; Kidney Neoplasms/drug therapy ; Kidney Neoplasms/mortality* ; Kidney Neoplasms/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 ; Ureteral Neoplasms/mortality* ; Ureteral Neoplasms/surgery ; Urinary Tract/pathology
Keywords
Adjuvant chemotherapy ; Kidney pelvis ; Transitional cell carcinoma ; Ureter ; Urinary tract
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.
Files in This Item:
T201500246.pdf Download
DOI
10.4111/kju.2015.56.1.41
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Yang, Seung Choul(양승철)
Yoon, Young Eun(윤영은)
Lee, Kwang Suk(이광석) ORCID logo https://orcid.org/0000-0002-7961-8393
Choi, Kyung Hwa(최경화)
Han, Woong Kyu(한웅규) ORCID logo https://orcid.org/0000-0002-2527-4046
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/139305
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