Outcomes of stage II‑IV upper‑tract urothelial carcinoma and adjuvant chemotherapy for locally advanced cancer

Chang,Yi‑Huei; Hsiao,Po‑Jen; Chen,Guang‑Heng; Lin,Ching‑Chan; Chang,Chao‑Hsiang; Wu,Hsi‑Chin; Huang,Chi‑Ping; Yang,Chi‑Rei; Yeh,Su‑Peng

doi:10.3892/ol.2018.9672

January-2019 Volume 17 Issue 1

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January-2019 Volume 17 Issue 1

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Article

Outcomes of stage II‑IV upper‑tract urothelial carcinoma and adjuvant chemotherapy for locally advanced cancer

Authors:
- Yi‑Huei Chang
- Po‑Jen Hsiao
- Guang‑Heng Chen
- Ching‑Chan Lin
- Chao‑Hsiang Chang
- Hsi‑Chin Wu
- Chi‑Ping Huang
- Chi‑Rei Yang
- Su‑Peng Yeh
View Affiliations / Copyright

Affiliations: Department of Urology, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan, R.O.C., Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan, R.O.C.
Pages: 1341-1348
|
Published online on: November 7, 2018

https://doi.org/10.3892/ol.2018.9672
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Abstract

The present retrospective study aimed to examine the outcomes of stage II‑IV upper‑tract urothelial carcinoma (UTUC) and determine whether adjuvant chemotherapy is a beneficial treatment for patients with locally advanced UTUC (specifically, stage III‑IV). The analysis included 126 patients with muscle‑invasive UTUC who were treated between June 2003 and June 2012. All patients underwent laparoscopic or open nephroureterectomy and bladder cuff excision. Overall survival (OS), disease‑free survival (DFS), distant metastasis‑free survival (DMFS) and locoregional recurrence‑free survival (LRFS) were assessed. Outcomes were compared between groups of patients with stage II (high‑stage localized) disease, stage III‑IV (high‑stage locally advanced) disease treated with chemotherapy, and stage III‑IV disease not treated with chemotherapy. Among patients with high‑stage locally advanced UTUC (stage III‑IV), those who received adjuvant chemotherapy had significantly better rates of OS (67.1 vs. 33.7%; P=0.004), DFS (70.2 vs. 46.0%; P=0.030) and DMFS (86.3 vs. 65.2%; P=0.048) at 5‑years compared with those who did not undergo adjuvant chemotherapy. However, there was no significant difference between the 5‑year LRFS rates in these two groups (78.2 vs. 62.5%; P=0.525). Importantly, the survival curve of patients with high‑stage UTUC who received adjuvant chemotherapy was similar to that of patients with low‑stage UTUC who underwent surgery only. Multivariate analysis revealed that adjuvant chemotherapy was an independent risk factor for OS [without adjuvant chemotherapy vs. with adjuvant chemotherapy: Hazard ratio (HR), 0.29; 95% confidence interval (CI), 0.129‑0.654; P=0.003] and DFS (without adjuvant chemotherapy vs. with adjuvant chemotherapy: HR, 0.381; 95% CI, 0.168‑0.865; P=0.021). In conclusion, adjuvant chemotherapy may improve the outcome for patients with high‑stage locally advanced UTUC.

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1	Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A and Bray F: Bladder cancer incidence and mortality: A global overview and recent trends. Eur Urol. 71:96–108. 2017. View Article : Google Scholar : PubMed/NCBI
2	David KA, Mallin K, Milowsky MI, Ritchey J, Carroll PR and Nanus DM: Surveillance of urothelial carcinoma: Stage and grade migration, 1993–2005 and survival trends, 1993–2000. Cancer. 115:1435–1447. 2009. View Article : Google Scholar : PubMed/NCBI
3	Yang MH, Chen KK, Yen CC, Wang WS, Chang YH, Huang WJ, Fan FS, Chiou TJ, Liu JH and Chen PM: Unusually high incidence of upper urinary tract urothelial carcinoma in Taiwan. Urology. 59:681–687. 2002. View Article : Google Scholar : PubMed/NCBI
4	Stiborová M, Frei E, Breuer A, Bieler CA and Schmeiser HH: Aristolactam I a metabolite of aristolochic acid I upon activation forms an adduct found in DNA of patients with chinese herbs nephropathy. Exp Toxicol Pathol. 51:421–427. 1999. View Article : Google Scholar : PubMed/NCBI
5	Arlt VM, Stiborova M and Schmeiser HH: Aristolochic acid as a probable human cancer hazard in herbal remedies: A review. Mutagenesis. 17:265–277. 2002. View Article : Google Scholar : PubMed/NCBI
6	Deng CX: BRCA1: Cell cycle checkpoint, genetic instability, DNA damage response and cancer evolution. Nucleic Acids Res. 34:1416–1426. 2006. View Article : Google Scholar : PubMed/NCBI
7	Cosyns JP, Jadoul M, Squifflet JP, Wese FX and van Ypersele de Strihou C: Urothelial lesions in Chinese-herb nephropathy. Am J Kidney Dis. 33:1011–1017. 1999. View Article : Google Scholar : PubMed/NCBI
8	Rouprêt M, Babjuk M, Compérat E, Zigeuner R, Sylvester RJ, Burger M, Cowan NC, Böhle A, Van Rhijn BW, Kaasinen E, et al: European association of urology guidelines on upper urinary tract urothelial cell carcinoma: 2015 update. Eur Urol. 68:868–879. 2015. View Article : Google Scholar : PubMed/NCBI
9	Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E, Lotan Y, Weizer A, Raman JD and Wood CG: Upper Tract Urothelial Carcinoma Collaboration The Upper Tract Urothelial Carcinoma Collaboration: Outcomes of radical nephroureterectomy: A series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 115:1224–1233. 2009. View Article : Google Scholar : PubMed/NCBI
10	Edge SB and Compton CC: The American Joint Committee on Cancer: The 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 17:1471–1474. 2010. View Article : Google Scholar : PubMed/NCBI
11	Abouassaly R, Alibhai SM, Shah N, Timilshina N, Fleshner N and Finelli A: Troubling outcomes from population-level analysis of surgery for upper tract urothelial carcinoma. Urology. 76:895–901. 2010. View Article : Google Scholar : PubMed/NCBI
12	Audenet F, Yates DR, Cussenot O and Rouprêt M: The role of chemotherapy in the treatment of urothelial cell carcinoma of the upper urinary tract (UUT-UCC). Urol Oncol. 31:407–413. 2013. View Article : Google Scholar : PubMed/NCBI
13	Sternberg CN, Yagoda A, Scher HI, Watson RC, Geller N, Herr HW, Morse MJ, Sogani PC, Vaughan ED, Bander N, et al: Methotrexate, vinblastine, doxorubicin, and cisplatin for advanced transitional cell carcinoma of the urothelium. Efficacy and patterns of response and relapse. Cancer. 64:2448–2458. 1989. View Article : Google Scholar : PubMed/NCBI
14	Freiha F, Reese J and Torti FM: A randomized trial of radical cystectomy versus radical cystectomy plus cisplatin, vinblastine and methotrexate chemotherapy for muscle invasive bladder cancer. J Urol. 155:495–500. 1996. View Article : Google Scholar : PubMed/NCBI
15	Koppie TM, Shariat SF, Nelson EC, Margulis V, Remzi M, Montorsi F, Raman JD, Ziguener R, Suardi N, Weizer AZ, et al: Adjuvant chemotherapy for upper tract transitional cell carcinoma: Results from the Upper Tract UCC Consortium. J Urol. 179:1192008. View Article : Google Scholar
16	Kwak C, Lee SE, Jeong IG and Ku JH: Adjuvant systemic chemotherapy in the treatment of patients with invasive transitional cell carcinoma of the upper urinary tract. Urology. 68:53–57. 2006. View Article : Google Scholar : PubMed/NCBI
17	Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H and Tanabe K: Primary site and incidence of lymph node metastases in urothelial carcinoma of upper urinary tract. Urology. 69:265–269. 2007. View Article : Google Scholar : PubMed/NCBI
18	Sobin LH, Gospodarowicz MK and Wittekind C: Renal pelvis and ureter. TNM Online. 258–261. 2010.https://doi.org/10.1002/9780471420194.tnmc43.pub2 View Article : Google Scholar
19	Lopez-Beltran A, Bassi P, Pavone-Macaluso M and Montironi R: Handling and pathology reporting of specimens with carcinoma of the urinary bladder, ureter, and renal pelvis. Eur Urol. 45:257–266. 2004. View Article : Google Scholar : PubMed/NCBI
20	Saito K, Kawakami S, Fujii Y, Sakura M, Masuda H and Kihara K: Lymphovascular invasion is independently associated with poor prognosis in patients with localized upper urinary tract urothelial carcinoma treated surgically. J Urol. 178:2291–2296. 2007. View Article : Google Scholar : PubMed/NCBI
21	National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Am J Kidney Dis. 39 2 Suppl 1:S1–S266. 2002.PubMed/NCBI
22	Hsiao PJ, Hsieh PF, Chang CH, Wu HC, Yang CR and Huang CP: Higher risk of urothelial carcinoma in the upper urinary tract than in the urinary bladder in hemodialysis patients. Ren Fail. 38:663–670. 2016. View Article : Google Scholar : PubMed/NCBI
23	Ho GY, Woodward N and Coward JI: Cisplatin versus carboplatin: Comparative review of therapeutic management in solid malignancies. Crit Rev Oncol Hematol. 102:37–46. 2016. View Article : Google Scholar : PubMed/NCBI
24	Dreicer R, Manola J, Roth BJ, See WA, Kuross S, Edelman MJ, Hudes GR and Wilding G: Phase III trial of methotrexate, vinblastine, doxorubicin, and cisplatin versus carboplatin and paclitaxel in patients with advanced carcinoma of the urothelium. Cancer. 100:1639–1645. 2004. View Article : Google Scholar : PubMed/NCBI
25	Leow JJ, Martin-Doyle W, Fay AP, Choueiri TK, Chang SL and Bellmunt J: A systematic review and meta-analysis of adjuvant and neoadjuvant chemotherapy for upper tract urothelial carcinoma. Eur Urol. 66:529–541. 2014. View Article : Google Scholar : PubMed/NCBI
26	Vassilakopoulou M, de la Motte Rouge T, Colin P, Ouzzane A, Khayat D, Dimopoulos MA, Papadimitriou CA, Bamias A, Pignot G, Nouhaud FX, et al: Outcomes after adjuvant chemotherapy in the treatment of high-risk urothelial carcinoma of the upper urinary tract (UUT-UC): Results from a large multicenter collaborative study. Cancer. 117:5500–5508. 2011. View Article : Google Scholar : PubMed/NCBI
27	Hellenthal NJ, Shariat SF, Margulis V, Karakiewicz PI, Roscigno M, Bolenz C, Remzi M, Weizer A, Zigeuner R, Bensalah K, et al: Adjuvant chemotherapy for high risk upper tract urothelial carcinoma: Results from the Upper Tract Urothelial Carcinoma Collaboration. J Urol. 182:900–906. 2009. View Article : Google Scholar : PubMed/NCBI
28	Soga N, Arima K and Sugimura Y: Adjuvant methotrexate, vinblastine, adriamycin, and cisplatin chemotherapy has potential to prevent recurrence of bladder tumors after surgical removal of upper urinary tract transitional cell carcinoma. Int J Urol. 15:800–803. 2008. View Article : Google Scholar : PubMed/NCBI
29	Koie T, Ohyama C, Hashimoto Y, Hatakeyama S, Yamamoto H, Yoneyama T and Kamimura N: Efficacies and safety of neoadjuvant gemcitabine plus carboplatin followed by immediate cystectomy in patients with muscle-invasive bladder cancer, including those unfit for cisplatin: A prospective single-arm study. Int J Clin Oncol. 18:724–730. 2013. View Article : Google Scholar : PubMed/NCBI
30	Mertens LS, Meijer RP, Kerst JM, Bergman AM, van Tinteren H, van Rhijn BW and Horenblas S: Carboplatin based induction chemotherapy for nonorgan confined bladder cancer-a reasonable alternative for cisplatin unfit patients? J Urol. 188:1108–1113. 2012. View Article : Google Scholar : PubMed/NCBI