Comparison of Pathological Stage in Patients Treated with and without Neoadjuvant Chemotherapy for High Risk Upper Tract Urothelial Carcinoma
2018; Lippincott Williams & Wilkins; Volume: 200; Issue: 1 Linguagem: Inglês
10.1016/j.juro.2017.12.054
ISSN1527-3792
AutoresRoss Liao, Mohit Gupta, Zeyad Schwen, Hiten D. Patel, Max Kates, Michael H. Johnson, Noah M. Hahn, David J. McConkey, Trinity J. Bivalacqua, Phillip M. Pierorazio,
Tópico(s)Urological Disorders and Treatments
ResumoNo AccessJournal of UrologyAdult Urology1 Jul 2018Comparison of Pathological Stage in Patients Treated with and without Neoadjuvant Chemotherapy for High Risk Upper Tract Urothelial Carcinoma Ross S. Liao, Mohit Gupta, Zeyad R. Schwen, Hiten D. Patel, Max Kates, Michael H. Johnson, Noah M. Hahn, David McConkey, Trinity J. Bivalacqua, and Phillip M. Pierorazio Ross S. LiaoRoss S. Liao Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland , Mohit GuptaMohit Gupta Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland , Zeyad R. SchwenZeyad R. Schwen Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland , Hiten D. PatelHiten D. Patel Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland , Max KatesMax Kates Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland The Greenberg Bladder Cancer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland , Michael H. JohnsonMichael H. Johnson Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland The Greenberg Bladder Cancer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland , Noah M. HahnNoah M. Hahn Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland The Greenberg Bladder Cancer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland , David McConkeyDavid McConkey Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland The Greenberg Bladder Cancer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland , Trinity J. BivalacquaTrinity J. Bivalacqua Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland , and Phillip M. PierorazioPhillip M. Pierorazio Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland The Greenberg Bladder Cancer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland View All Author Informationhttps://doi.org/10.1016/j.juro.2017.12.054AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: High risk upper tract urothelial carcinoma has been associated with poor survival outcomes. Limited retrospective data support neoadjuvant chemotherapy prior to radical nephroureterectomy. To validate prior findings we evaluated differences in the pathological stage distribution in patients with high risk upper tract urothelial carcinoma based on the administration of neoadjuvant chemotherapy before radical nephroureterectomy. Materials and Methods: We retrospectively analyzed the records of 240 patients with upper tract urothelial carcinoma at The Johns Hopkins Hospital from 2003 to 2017. Patients with biopsy proven high grade disease and a visible lesion on cross-sectional imaging were offered neoadjuvant chemotherapy prior to radical nephroureterectomy. A control group of a time matched cohort of patients with biopsy proven high grade disease underwent extirpative surgery alone. The chi-square and Fisher exact tests were used to evaluate clinical and pathological variables between the cohorts. Results: There were 32 patients in the study group and 208 in the control group. Significantly lower pathological stage was noted in the study group than in the control group (p <0.001). Significantly fewer patients with pT2 disease or higher were treated with neoadjuvant chemotherapy (37.5% vs 59.6%, p = 0.02). There was a 46.5% reduction in the prevalence of pT3 disease or higher in study group patients without clinically node positive or low volume metastatic disease (25.9% vs 48.4%, p = 0.04). A 9.4% complete remission rate was observed in patients who underwent neoadjuvant chemotherapy. Conclusions: Patients with high risk upper tract urothelial carcinoma treated with neoadjuvant chemotherapy were noted to have a lower pathological stage distribution than patients treated with radical nephroureterectomy alone. References 1 : Transitional cell carcinoma of the ureter and renal pelvis. Crit Rev Oncol Hematol2003; 47: 155. Google Scholar 2 : Ureteroscopic management of upper tract transitional cell carcinoma. Urol Clin North Am2004; 31: 115. Google Scholar 3 : Comparison of open nephroureterectomy and ureteroscopic and percutaneous management of upper urinary tract transitional cell carcinoma. Urology2006; 67: 1181. 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Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byFoerster B, Abufaraj M, Petros F, Azizi M, Gupta M, Schweitzer D, Margulis V, Iwata T, Kimura S, Shabsigh A, Briganti A, Ku J, Muilwijk T, Kassouf W, Matin S, Spiess P, Pierorazio P, Hendricksen K, Shariat S, Clinton T, Broutian T, Bandini M, Monteiro L, Liao R, Moschini M, Bivalacqua T, Krabbe L, Nasu Y, Egawa S, Joniau S, John H, van der Heijden M, Glybochko P, Fajkovic H, Singla N and Necchi A (2020) Efficacy of Preoperative Chemotherapy for High Risk Upper Tract Urothelial CarcinomaJournal of Urology, VOL. 203, NO. 6, (1101-1108), Online publication date: 1-Jun-2020.Smith J (2018) This Month in Adult UrologyJournal of Urology, VOL. 200, NO. 1, (1-2), Online publication date: 1-Jul-2018. Volume 200Issue 1July 2018Page: 68-73Supplementary Materials Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordsneoadjuvant therapytransitional cellchemotherapycarcinomaureteral neoplasmskidney neoplasmsMetricsAuthor Information Ross S. Liao Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Mohit Gupta Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Zeyad R. Schwen Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Hiten D. Patel Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Max Kates Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland The Greenberg Bladder Cancer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Michael H. Johnson Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland The Greenberg Bladder Cancer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Noah M. Hahn Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland The Greenberg Bladder Cancer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author David McConkey Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland The Greenberg Bladder Cancer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Trinity J. Bivalacqua Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Phillip M. Pierorazio Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland The Greenberg Bladder Cancer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Expand All Advertisement PDF downloadLoading ...
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