Clinical Efficacy of Adjuvant Chemotherapy in Advanced Upper Tract Urothelial Carcinoma (pT3-T4): Real-World Data from the Taiwan Upper Tract Urothelial Carcinoma Collaboration Group

Chung-Yu Lin; Han-Yu Weng; Ta-Yao Tai; Hsi-Chin Wu; Wen-Chi Chen; Chung-Hsin Chen; Chao-Yuan Huang; Chi-Wen Lo; Chih-Chin Yu; Chung-You Tsai; Wei-Che Wu; Yuan-Hong Jiang; Yu-Khun Lee; Thomas Y Hsueh; Allen W Chiu; Bing-Juin Chiang; Hsu-Che Huang; I-Hsuan Alan Chen; Yung-Tai Chen; Wei-Yu Lin; Chia-Chang Wu; Yao-Chou Tsai; Hsiang-Ying Lee; Wei-Ming Li

doi:10.3390/jpm12020226

Clinical Efficacy of Adjuvant Chemotherapy in Advanced Upper Tract Urothelial Carcinoma (pT3-T4): Real-World Data from the Taiwan Upper Tract Urothelial Carcinoma Collaboration Group

J Pers Med. 2022 Feb 6;12(2):226. doi: 10.3390/jpm12020226.

Authors

Chung-Yu Lin¹, Han-Yu Weng², Ta-Yao Tai², Hsi-Chin Wu^{3

4

5}, Wen-Chi Chen^{3

6}, Chung-Hsin Chen⁷, Chao-Yuan Huang⁷, Chi-Wen Lo⁸, Chih-Chin Yu^{8

9}, Chung-You Tsai^{10

11}, Wei-Che Wu^{10

12}, Yuan-Hong Jiang¹³, Yu-Khun Lee¹³, Thomas Y Hsueh^{14

15}, Allen W Chiu¹⁶, Bing-Juin Chiang^{17

18

19}, Hsu-Che Huang^{18

19}, I-Hsuan Alan Chen²⁰, Yung-Tai Chen²¹, Wei-Yu Lin^{22

23

24}, Chia-Chang Wu^{25

26

27}, Yao-Chou Tsai^{26

28}, Hsiang-Ying Lee^{1

29}, Wei-Ming Li^{1

29

30

31}

Affiliations

¹ Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
² Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
³ Department of Urology, China Medical University Hospital, Taichung 404, Taiwan.
⁴ School of Medicine, China Medical University, Taichung 404, Taiwan.
⁵ Department of Urology, China Medical University Beigang Hospital, Yunlin 651, Taiwan.
⁶ Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan.
⁷ Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 100, Taiwan.
⁸ Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City 231, Taiwan.
⁹ School of Medicine, Buddhist Tzu Chi University, Hualien 970, Taiwan.
¹⁰ Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan.
¹¹ Department of Healthcare Information and Management, Ming Chuan University, Taipei 111, Taiwan.
¹² Institute of Biomedical Engineering, National Taiwan University, Taipei 106, Taiwan.
¹³ Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 970, Taiwan.
¹⁴ Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei 106, Taiwan.
¹⁵ Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
¹⁶ College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
¹⁷ College of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan.
¹⁸ Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City 231, Taiwan.
¹⁹ Department of Life Science, College of Science, National Taiwan Normal University, Taipei 116, Taiwan.
²⁰ Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan.
²¹ Department of Urology, Taiwan Adventist Hospital, Taipei 105, Taiwan.
²² Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi 613, Taiwan.
²³ Chang Gung University of Science and Technology, Chia-Yi 613, Taiwan.
²⁴ Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
²⁵ Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan.
²⁶ Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
²⁷ TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei 110, Taiwan.
²⁸ Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei 110, Taiwan.
²⁹ Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
³⁰ Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
³¹ Department of Urology, Ministry of Health and Welfare, Pingtung Hospital, Pingtung 900, Taiwan.

Abstract

The clinical efficacy of adjuvant chemotherapy in upper tract urothelial carcinoma (UTUC) is unclear. We aimed to assess the therapeutic outcomes of adjuvant chemotherapy in patients with advanced UTUC (pT3-T4) after radical nephroureterectomy (RNU). We retrospectively reviewed the data of 2108 patients from the Taiwan UTUC Collaboration Group between 1988 and 2018. Comprehensive clinical features, pathological characteristics, and survival outcomes were recorded. Univariate and multivariate Cox proportional hazards models were used to evaluate overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Of the 533 patients with advanced UTUC included, 161 (30.2%) received adjuvant chemotherapy. In the multivariate analysis, adjuvant chemotherapy was significantly associated with a reduced risk of overall death (hazard ratio (HR), 0.599; 95% confidence interval (CI), 0.419-0.857; p = 0.005), cancer-specific mortality (HR, 0.598; 95% CI, 0.391-0.914; p = 0.018), and cancer recurrence (HR, 0.456; 95% CI, 0.310-0.673; p < 0.001). The Kaplan-Meier survival analysis revealed that patients receiving adjuvant chemotherapy had significantly better five-year OS (64% vs. 50%, p = 0.002), CSS (70% vs. 62%, p = 0.043), and DFS (60% vs. 48%, p = 0.002) rates compared to those who did not receive adjuvant chemotherapy. In conclusion, adjuvant chemotherapy after RNU had significant therapeutic benefits on OS, CSS, and DFS in advanced UTUC.

Keywords: chemotherapy; prognosis; upper tract urothelial carcinoma.

Abstract

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