Adjuvant Chemo May Lengthen OS After Radical Surgery for Upper Tract Urothelial Carcinoma

Observational data point to the use of adjuvant chemotherapy in patients undergoing radical surgery for upper tract urothelial carcinoma

medwireNews: A review of patients who underwent radical nephroureterectomy (RNU) for locally advanced or regional lymph node-positive upper tract urothelial carcinoma (UTUC) suggests there may be an overall survival (OS) benefit with the use of adjuvant chemotherapy.

“Although our results are limited by the usual biases related to the observational study design, we believe that the present findings should be considered when advising post-RNU management of advanced UTUC, pending level I evidence”, the investigators write in the Journal of Clinical Oncology.

Steven Chang, from Brigham and Women's Hospital in Boston, Massachusetts, USA, and co-authors collated information from the National Cancer Database for 3253 pT3/T4 and/or pN+ UTUC patients who received post-RNU chemotherapy or observation between 2004 and 2012. Patients became more likely to receive adjuvant chemotherapy over time, with an annual percent change of 0.60%.

Analysis showed that the median OS was significantly longer for the 762 patients who were given postoperative chemotherapy after a median of 47 days than the 2491 patients who were given no additional treatment, at 47.41 versus 35.78 months.

And after adjusting for the inverse probability of treatment weighting, the 5-year rates of OS were 43.90% for the adjuvant chemotherapy group versus 35.85% for the observation group.

Taking into consideration age, gender, Charlson comorbidity index, pathological stage and surgical margin status, receipt of adjuvant chemotherapy continued to provide a significant OS benefit over observation, with a hazard ratio (HR) of 0.77.

The researchers emphasize that the significant impact of adjuvant chemotherapy was true for all the patient subgroups studied, with no significant heterogeneity of treatment effect, giving HRs between 0.64 and 0.84 for OS in favour of postoperative treatment.

“This report represents the first sizeable assessment of the comparative effectiveness of [adjuvant chemotherapy] dedicated to patients with UTUC who were undergoing upfront RNU, which is currently the most frequent treatment strategy for cN0M0 disease—in the absence of robust data to support the use of [neoadjuvant chemotherapy]”, Steven Chang et al summarise. 

Nevertheless, they caution that their study focused on OS and note that “several other aspects of [adjuvant chemotherapy], such as hematologic and nonhematologic toxicity, should be considered when dealing with advanced UTUC, as they may substantially impact quality of life.” 

Reference

Seisen T, Krasnow RE, Bellmunt J, et al. Effectiveness of adjuvant chemotherapy after radical nephroureterectomy for locally advanced and/or positive regional lymph node upper tract urothelial carcinoma.J Clin Oncol; Advance online publication 3 January 2017. DOI: 10.1200/JCO.2016.69.4141

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