Adjuvant treatments for advanced stage, non-metastatic upper tract urothelial carcinoma: A multicenter study
Menée à partir de données portant sur 222 patients traités par néphro-urétérectomie pour un carcinome urothélial non métastatique des voies excrétrices supérieures de stade pT3bN0-x (durée médiane de suivi : 34,4 mois), cette étude multicentrique évalue l'effet d'un traitement adjuvant comportant une radiothérapie et/ou une chimiothérapie sur la survie sans récidive locale, la survie sans métastase distante ou la survie spécifique
Purpose : We assessed the efficacy of adjuvant treatments in patients with peripelvic/ periureteral fat-infiltrating (pT3b), non-metastatic upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy. Materials and Methods : The multicenter data of 222 patients with pT3bN0-x disease treated with radical nephroureterectomy were analyzed. The effects of adjuvant radiotherapy and chemotherapy on local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS) were evaluated. Results : Adjuvant radiotherapy and chemotherapy were given to 39 (17.6%) and 74 patients (33.3%), respectively. Seventeen patients (7.7%) received concomitant adjuvant radiotherapy and chemotherapy. The median follow-up duration was 34.4 months. After adjusting for age, sex, tumor location, multifocality, tumor grade, presence of lymphovascular invasion, surgical margin, execution of node dissection, and other types of concomitant adjuvant treatment (radiotherapy or chemotherapy) through propensity-scored matching, adjuvant radiotherapy significantly reduced the local recurrence (5-year LRFS, 83.9 vs. 54.2%; p=0.001), distant metastasis (5-year DMFS, 72.1 vs. 48.1%; p=0.032), and cancer-specific death (5-year CSS, 76.4 vs. 55.5%; p=0.038) in pT3b UTUC. However, in the same condition, adjuvant chemotherapy did not reduce the local recurrence (5-year LRFS, 69.0 vs. 66.2%; p=0.786), distant metastasis (5-year DMFS, 65.3 vs. 61.1%; p=0.436), and cancer-specific death (5-year CSS, 67.9 vs. 67.9%; p=0.458) in pT3b UTUC. Conclusion : Our study suggests that adjuvant radiation therapy may be beneficial in patients with T3bN0-x UTUC; however, prospective clinical trials are needed to clarify this issue.
https://www.redjournal.org/article/S0360-3016(19)30386-4/fulltext