Pathologic stage as a surrogate for oncologic outcomes after receipt of neoadjuvant chemotherapy for high-grade upper tract urothelial carcinoma.
Neoadjuvant chemotherapy
Pathologic response
Radical nephroureterectomy
Upper tract urothelial carcinoma
Journal
Urologic oncology
ISSN: 1873-2496
Titre abrégé: Urol Oncol
Pays: United States
ID NLM: 9805460
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
02
03
2020
revised:
26
03
2020
accepted:
24
04
2020
pubmed:
21
5
2020
medline:
6
8
2021
entrez:
21
5
2020
Statut:
ppublish
Résumé
Whether pathologic stage at radical nephroureterectomy (RNU) can serve as an appropriate surrogate for oncologic outcomes in patients with high-grade (HG) upper tract urothelial carcinoma (UTUC) treated with neoadjuvant chemotherapy (NAC) is not defined. We sought to determine whether patients who achieve pathologically non-muscle-invasive (ypT0, ypTa, ypT1, ypTis) HG UTUC after receipt of NAC exhibit oncologic outcomes comparable to those who are inherently low stage without chemotherapy. We identified 647 UTUC patients who underwent RNU among 3 institutions from 1993to2016. Patients with low or unknown grade, pathologic muscle invasion, or receipt of adjuvant chemotherapy were excluded. We compared clinicopathologic data and oncologic outcomes between pT0-1 and ypT0-1 patients. Kaplan-Meier analysis was used to assess overall (OS), cancer-specific (CSS), and systemic recurrence-free (RFS) survival. Predictors of these endpoints were identified using Cox regression. 234 (43 ypT0-1, 191 pT0-1) patients with HG UTUC were included. Two patients exhibited pathologic complete response after NAC. OS (P = 0.055), CSS (P = 0.152), and RFS (P = 0.098) were similar between ypT0-1 and pT0-1 patients. Predictors of worse outcomes included African-American race (RFS, CSS, and OS), Charlson score (OS), and systemic recurrence (OS and CSS). Patients with HG UTUC who achieve ypT0-1 stage after NAC exhibit favorable oncologic outcomes comparable to those inherently non-muscle-invasive who do not receive chemotherapy. Improvements in clinical staging will play an important role in better defining candidacy for NAC in treating HG UTUC while minimizing overtreatment. Furthermore, pathologic stage may serve as an appropriate early surrogate for oncologic endpoints in designing clinical trials.
Identifiants
pubmed: 32430254
pii: S1078-1439(20)30180-0
doi: 10.1016/j.urolonc.2020.04.025
pmc: PMC10676742
mid: NIHMS1588615
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
933.e7-933.e12Subventions
Organisme : NCI NIH HHS
ID : L30 CA129564
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Références
Eur J Cancer. 2009 Dec;45(18):3291-7
pubmed: 19615885
Urology. 2016 Oct;96:44-53
pubmed: 27443467
BJU Int. 2013 Aug;112(4):453-61
pubmed: 23464979
BJU Int. 2012 Jan;109(1):77-82
pubmed: 21631698
Oncotarget. 2017 Oct 06;8(60):101500-101508
pubmed: 29254181
Eur Urol. 2008 Apr;53(4):720-31
pubmed: 18207315
Eur Urol. 2012 Oct;62(4):677-84
pubmed: 22349570
Int J Mol Sci. 2019 Feb 13;20(4):
pubmed: 30781730
N Engl J Med. 2003 Aug 28;349(9):859-66
pubmed: 12944571
Eur Urol. 2007 May;51(5):1281-8
pubmed: 17125909
Cancer. 2009 Mar 15;115(6):1224-33
pubmed: 19156917
Eur Urol. 2014 Sep;66(3):529-41
pubmed: 24680361
Eur Urol. 2010 Oct;58(4):581-7
pubmed: 20619530
J Urol. 2018 Jul;200(1):68-73
pubmed: 29307680
Clin Genitourin Cancer. 2018 Dec;16(6):e1237-e1242
pubmed: 30217764
Eur Urol. 2010 Jun;57(6):956-62
pubmed: 20018438
World J Urol. 2017 Sep;35(9):1401-1407
pubmed: 28074261
Urol Oncol. 2014 Jan;32(1):47.e9-14
pubmed: 24140248
Urol Oncol. 2017 Jun;35(6):322-327
pubmed: 28065502
J Urol. 2009 Jun;181(6):2482-9
pubmed: 19371878
BJU Int. 2019 Oct;124(4):665-671
pubmed: 30801918
Urology. 2010 Feb;75(2):321-7
pubmed: 19962727
J Clin Oncol. 2016 Jun 1;34(16):1945-52
pubmed: 27001593
Cancer. 2014 Jun 15;120(12):1794-9
pubmed: 24633966
Eur Urol. 2018 Jan;73(1):111-122
pubmed: 28867446
Urology. 2019 Jul;129:146-152
pubmed: 30930207
Urol Oncol. 2015 Jun;33(6):268.e1-7
pubmed: 25862284
Cancer. 2010 Jul 1;116(13):3127-34
pubmed: 20564621