Survival Effect of Nephroureterectomy in Metastatic Upper Urinary Tract Urothelial Carcinoma.
Chemotherapy
SEER
UTUC
Upper tract
Urothelial carcinoma
Journal
Clinical genitourinary cancer
ISSN: 1938-0682
Titre abrégé: Clin Genitourin Cancer
Pays: United States
ID NLM: 101260955
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
06
01
2019
revised:
03
03
2019
accepted:
05
03
2019
pubmed:
22
4
2019
medline:
28
3
2020
entrez:
22
4
2019
Statut:
ppublish
Résumé
Few data examined the potential survival benefit of nephroureterectomy (NU) in the setting of metastatic upper urinary tract urothelial carcinoma (mUTUC). We hypothesized that a survival benefit might be associated with the use of NU in that setting and tested this hypothesis within a large population-based cohort. Within the Surveillance, Epidemiology, and End Results database (2004-2014), we identified 1174 patients with mUTUC. Kaplan-Meier plots, as well as multivariable Cox regression models (MCRMs), relying on inverse probability after treatment weighting and landmark analyses, were used to test the effect of NU versus no surgical treatment on cancer-specific mortality (CSM) in patients with mUTUC. Of 1174 patients with mUTUC, 449 (38%) underwent NU. The rate of NU decreased over time from 47.1% to 34.6% (estimated annual percentage change, -4%; P = .006]. In MCRMs, NU achieved independent predictor status for lower CSM (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.46-0.66; P < .001). In MCRMs stratified according to chemotherapy, NU also achieved independent predictor status for lower CSM, both in patients who received (n = 597; 50.9%) (HR, 0.68; 95% CI, 0.53-0.87; P = .002) or did not receive (n = 574; 49%) (HR, 0.44; 95% CI, 0.33-0.58; P < .001) chemotherapy. Virtually the same results were recorded after inverse probability after treatment weighting adjustment, as well as in landmark analyses. Our analyses suggest a potential survival benefit after NU in the setting of mUTUC, regardless of chemotherapy administration.
Sections du résumé
BACKGROUND
Few data examined the potential survival benefit of nephroureterectomy (NU) in the setting of metastatic upper urinary tract urothelial carcinoma (mUTUC). We hypothesized that a survival benefit might be associated with the use of NU in that setting and tested this hypothesis within a large population-based cohort.
PATIENTS AND METHODS
Within the Surveillance, Epidemiology, and End Results database (2004-2014), we identified 1174 patients with mUTUC. Kaplan-Meier plots, as well as multivariable Cox regression models (MCRMs), relying on inverse probability after treatment weighting and landmark analyses, were used to test the effect of NU versus no surgical treatment on cancer-specific mortality (CSM) in patients with mUTUC.
RESULTS
Of 1174 patients with mUTUC, 449 (38%) underwent NU. The rate of NU decreased over time from 47.1% to 34.6% (estimated annual percentage change, -4%; P = .006]. In MCRMs, NU achieved independent predictor status for lower CSM (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.46-0.66; P < .001). In MCRMs stratified according to chemotherapy, NU also achieved independent predictor status for lower CSM, both in patients who received (n = 597; 50.9%) (HR, 0.68; 95% CI, 0.53-0.87; P = .002) or did not receive (n = 574; 49%) (HR, 0.44; 95% CI, 0.33-0.58; P < .001) chemotherapy. Virtually the same results were recorded after inverse probability after treatment weighting adjustment, as well as in landmark analyses.
CONCLUSIONS
Our analyses suggest a potential survival benefit after NU in the setting of mUTUC, regardless of chemotherapy administration.
Identifiants
pubmed: 31005472
pii: S1558-7673(19)30083-7
doi: 10.1016/j.clgc.2019.03.003
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e602-e611Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.