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01-07-2019 | Original Article

Survival effect of perioperative systemic chemotherapy on overall mortality in locally advanced and/or positive regional lymph node non-metastatic urothelial carcinoma of the upper urinary tract

Authors: Sebastiano Nazzani, Felix Preisser, Elio Mazzone, Zhe Tian, Francesco A. Mistretta, Shahrokh F. Shariat, Denis Soulières, Fred Saad, Emanuele Montanari, Stefano Luzzago, Alberto Briganti, Luca Carmignani, Pierre I. Karakiewicz

Published in: World Journal of Urology | Issue 7/2019

Abstract

Objectives

To analyze the potential survival benefit of perioperative chemotherapy (CHT) in patients treated with nephroureterectomy (NU) for non-metastatic locally advanced upper tract urothelial carcinoma.

Methods

Within the Surveillance, Epidemiology, and End Results database (2004–2014), we identified 1286 patients with T3 or T4, N 0–3 M0 UTUC. Kaplan–Meier plots, as well as multivariable Cox regression models (MCRMs) relying on inverse probability after treatment weighting (IPTW) and landmark analyses, were used to test the effect of CHT vs no CHT on overall mortality (OM) in the overall population (n =1286), as well as after stratification according to lymph node invasion (LNI).

Results

Overall, 37.4% patients received CHT. The CHT rate was higher with LNI (62.2% vs 35.2%, p < 0.001). In MCRMs, testing for OM in the overall population, CHT was associated with lower rates of OM (HR 0.71, CI 0.58–0.87; p = 0.001). Similarly, in MCRMs testing for OM in patients with LNI, CHT achieved independent predictor status for lower OM (HR 0.61, CI 0.48–0.78; p < 0.001). Conversely, in MCRMs testing for OM in patients without LNI, no CHT effect was recorded (HR 0.72, CI 0.52–1.01; p = 0.05). All results were confirmed after IPTW adjustment and in landmark analyses.

Conclusions

Our results represent a contemporary North American report indicating lower OM after CHT for patients with locally advanced non-metastatic upper tract urothelial carcinoma, specifically in patients with T3–T4, N1–N3, M0 disease. Validation of the current and of the previous study is required within a randomized prospective design.

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Title: Survival effect of perioperative systemic chemotherapy on overall mortality in locally advanced and/or positive regional lymph node non-metastatic urothelial carcinoma of the upper urinary tract
Authors: Sebastiano Nazzani
Felix Preisser
Elio Mazzone
Zhe Tian
Francesco A. Mistretta
Shahrokh F. Shariat
Denis Soulières
Fred Saad
Emanuele Montanari
Stefano Luzzago
Alberto Briganti
Luca Carmignani
Pierre I. Karakiewicz
Publication date: 01-07-2019
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 7/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2516-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Survival effect of perioperative systemic chemotherapy on overall mortality in locally advanced and/or positive regional lymph node non-metastatic urothelial carcinoma of the upper urinary tract

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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