Neoadjuvant and adjuvant chemotherapy use in upper tract urothelial carcinoma

Abstract

Objective: To determine trends in neoadjuvant and adjuvant chemotherapy use for upper tract urothelial cancer and assess its effects on survival.

Materials and methods: We identified all patients diagnosed with upper tract urothelial cancer who underwent surgical treatment in the SEER-Medicare database from 2002 to 2011. We collected and analyzed patient demographic, clinical, and pathologic characteristics. We strictly defined neoadjuvant and adjuvant chemotherapy and studied patients who met such criteria. Multivariable Cox proportional hazards models identified were used to identify independent predictors of overall and cancer-specific survival.

Results: A total of 3,432 patients met inclusion criteria, and their median age was 77 years. Overall, 86.4% of patients underwent surgery alone, 1.8% received neoadjuvant chemotherapy plus surgery, and 11.8% underwent surgery and adjuvant chemotherapy. Neoadjuvant chemotherapy use increased during the study period. Gemcitabine, carboplatin, cisplatin, and paclitaxel were the most commonly used agents. Cancer-specific survival at 5 years was 65.0% (95% CI: 63.2%-66.8%). Cox proportional hazards modeling controlling for sex, race, year of diagnosis, location, and pathologic stage revealed that higher pathologic nodal stage, tumor size>3cm, increased age, and carcinoma in situ predicted for worse survival.

Conclusion: Age, nodal stage, and tumor size>3cm predict for worse cancer-specific survival. Neoajduvant chemotherapy is underused.

Keywords: Chemotherapy; Neoadjuvant; Nephroureterectomy; SEER-medicare; Upper tract transitional cell carcinoma; Upper tract urothelial cancer.