Adjuvant chemotherapy may improve overall survival in patients who have nonmetastatic, node-negative upper tract urothelial carcinoma (UTUC) with vascular invasion, according to new study findings.
In a matched cohort, 49 patients had radical nephroureterectomy (RNU) alone and 49 had RNU followed by adjuvant chemotherapy (AC). Investigators matched patients by age at diagnosis, sex, side affected by cancer (right or left), hydronephrosis, pathological T stage, lymph and/or vascular invasion, histology, and neoadjuvant chemotherapy.
RNU + AC patients had significantly higher overall survival rates at 5 years than RNU-only patients (72.7% vs 51.6%), Tomohisa Matsunaga, MD, of Osaka Medical College in Japan, and colleagues reported in World Journal of Urology. Pathologic vascular invasion was significantly associated with a 3.4-fold higher risk for all-cause mortality compared with no vascular invasion. In contrast, AC significantly correlated with a 55% lower death risk compared with no chemotherapy.
Among the 51 patients with pathologic vascular invasion, the RNU + AC group had significantly longer overall survival (70 vs 30 months). The investigators found no significant overall survival difference among patients without vascular invasion, whether they underwent RNU or RNU + AC.
Dr Matsunaga’s team observed no significant survival difference between patients receiving methotrexate-vinblastine-adriamycin-cisplatin (MVAC) or gemcitabine-cisplatin. A median number of 2 chemotherapy cycles in the MVAC and gemcitabine-cisplatin groups appeared to offer a survival advantage.
“Given that this survival benefit by AC was restricted to patients with the vascular invasion, it is plausible that the pathological review from the specimen of RNU, which is a major advantage in AC unlike NAC [neoadjuvant chemotherapy], would be a definitive indicator to identify the patients who are likely to benefit from AC after RNU,” Dr Matsunaga and colleagues stated.
Cancer-specific survival at 5 years also was significantly longer in the RNU + AC group than those treated with RNU alone (72.7% vs 54%), the investigators reported. Bladder cancer recurrence-free survival did not differ.
Previous or concurrent bladder cancer at UTUC diagnosis could have influenced the survival rate associated with AC, which is a limitation, according to the authors. Residual glomerular filtration rate after surgery also likely influenced the decision to administer AC.
Matsunaga T, Komura K, Hashimoto T, et al. Adjuvant chemotherapy improves overall survival in patients with localized upper tract urothelial carcinoma harboring pathologic vascular invasion: a propensity score‑matched analysis of multi‑institutional cohort [published online February 17, 2020]. World J Urol. doi: 10.1007/s00345-020-03118-x