Adjuvant Chemo After Nephroureterectomy May Aid Survival in UTUC
Adjuvant chemo is associated with overall survival benefit in patients with locally advanced and/or positive regional lymph node disease.
HealthDay News — For patients undergoing radical nephroureterectomy (RNU) for pT3/T4 and/or pN+ upper tract urothelial carcinoma (UTUC), adjuvant chemotherapy (AC) use is associated with an overall survival benefit, according to a study published online in the Journal of Clinical Oncology.
Thomas Seisen, MD, from Brigham and Women's Hospital in Boston, and colleagues identified 3253 individuals within the National Cancer Database who received AC or observation after RNU for pT3/T4 and/or pN+ UTUC. Overall survival (OS) was compared for patients in the two treatment groups.
The researchers found that after RNU, 762 (23.42%) and 2491 (76.58%) patients with pT3/T4 and/or pN+ UTUC received AC and observation, respectively. Median OS was significantly longer for AC versus observation (47.41 vs 35.78 months) in inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier curves. For AC versus observation, the 5-year IPTW-adjusted rates of OS were 43.90% and 35.85%, respectively. AC correlated with a significant OS benefit in IPTW-adjusted Cox proportional hazards regression analysis (hazard ratio, 0.77). Across all subgroups this benefit was consistent, with no significant heterogeneity of treatment effect.
"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 authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
- 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. 3 January 2017. DOI: 10.1200/JCO.2016.69.4141