Impact of adjuvant chemotherapy in patients with upper tract urothelial carcinoma and lymphovascular invasion after radical nephroureterectomy
이광석, 김광현, 윤영은, 최경화, 양승철, 한웅규,
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이광석 ( Lee Kwang-Suk )
Yonsei University College of Medicine Urological Science Institute Department of Urology
김광현 ( Kim Kwang-Hyun )
Ewha Womans University Mokdong Hospital Department of Urology
윤영은 ( Yoon Young-Eun )
Yonsei University College of Medicine Urological Science Institute Department of Urology
최경화 ( Choi Kyung-Hwa )
Yonsei University College of Medicine Urological Science Institute Department of Urology
양승철 ( Yang Seung-Choul )
Yonsei University College of Medicine Urological Science Institute Department of Urology
한웅규 ( Han Woong-Kyu )
Yonsei University College of Medicine Urological Science Institute Department of Urology
KMID : 0358320150560010041
Abstract
Purpose: To evaluate the impact of adjuvant chemotherapy (AC) in patients with upper tract urothelial carcinoma and lymphovascular invasion (LVI) after radical nephroureterectomy (RNU).
Materials and Methods: We retrospectively analyzed the clinical records and clinicopatholgic outcomes of patients (n=552) treated with RNU between 1986 and 2013. Patients treated with neoadjuvant chemotherapy and those for whom LVI status was not recorded were excluded. Patients were divided into two groups according to LVI (n=86) or no LVI (n=256).
Results: The study included 344 patients (240 men and 104 women) with a median of 53.9 months of follow-up (range, 1-297 months) after RNU. Tumors were organ confined (T2/N0) in 211 (61.3%) and tumor grade high in 291 (84.6%). AC was administered in 64 patients (18.6%). A total of 280 patients (81.4%) were treated with surgery alone. Patients with LVI tended to be older (p=0.049), have a higher pT stage (pT3/T4, p<0.001), be pN+ (p<0.001), have a high tumor grade (p<0.001), and experience recurrence (p<0.001). In the multivariate analysis, LVI was an independent prognostic factor for cancer-specific survival and overall survival (p=0.002 and p<0.001, respectively). The multivariate analysis demonstrated that in the subgroup of patients with LVI, AC was a significant prognostic factor for cancer-specific survival and overall survival (hazard ratio, 0.51; p=0.027 and hazard ratio, 0.50; p=0.025, respectively).
Conclusions: AC does not seem to reduce mortality in patients with advanced upper tract urothelial carcinoma after RNU. In the subgroup of patients with LVI, AC had a positive impact on cancer-specific survival and overall survival. LVI would be helpful for selecting patients who are appropriate for AC.
키워드
Adjuvant chemotherapy; Kidney pelvis; Transitional cell carcinoma; Ureter; Urinary tract
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