Impact of Adjuvant Chemotherapy on Variant Histology of Upper Tract Urothelial Carcinoma: A Propensity Score-Matched Cohort Analysis

Chi-Wen Lo; Wei-Ming Li; Hung-Lung Ke; Yi-Huei Chang; Hsi-Chin Wu; I-Hsuan Alan Chen; Jen-Tai Lin; Chao-Yuan Huang; Chung-Hsin Chen; Jen-Shu Tseng; Wun-Rong Lin; Yuan-Hong Jiang; Yu-Khun Lee; Chung-You Tsai; Shiu-Dong Chung; Thomas Y Hsueh; Allen W Chiu; Yeong-Chin Jou; Ian-Seng Cheong; Yung-Tai Chen; Jih-Sheng Chen; Bing-Juin Chiang; Chih-Chin Yu; Wei Yu Lin; Chia-Chang Wu; Chuan-Shu Chen; Han-Yu Weng; Yao-Chou Tsai

doi:10.3389/fonc.2022.843715

Impact of Adjuvant Chemotherapy on Variant Histology of Upper Tract Urothelial Carcinoma: A Propensity Score-Matched Cohort Analysis

Front Oncol. 2022 Apr 22:12:843715. doi: 10.3389/fonc.2022.843715. eCollection 2022.

Authors

Chi-Wen Lo^{1

2}, Wei-Ming Li^{3

4

5

6

7}, Hung-Lung Ke^{3

4

5

6

7}, Yi-Huei Chang^{8

9

10}, Hsi-Chin Wu^{8

9

10}, I-Hsuan Alan Chen¹¹, Jen-Tai Lin¹¹, Chao-Yuan Huang¹², Chung-Hsin Chen¹², Jen-Shu Tseng^{13

14

15}, Wun-Rong Lin^{13

14

15}, Yuan-Hong Jiang¹⁶, Yu-Khun Lee¹⁶, Chung-You Tsai^{17

18}, Shiu-Dong Chung^{17

19

20}, Thomas Y Hsueh^{21

22

23}, Allen W Chiu^{21

22

23}, Yeong-Chin Jou^{24

25}, Ian-Seng Cheong^{24

25}, Yung-Tai Chen²⁶, Jih-Sheng Chen²⁶, Bing-Juin Chiang^{27

28

29}, Chih-Chin Yu^{1

2}, Wei Yu Lin^{30

31

32}, Chia-Chang Wu^{33

34}, Chuan-Shu Chen^{35

36

37}, Han-Yu Weng³⁸, Yao-Chou Tsai^{1

2}

Affiliations

¹ Division of Urology, Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
² School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
³ Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁴ Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁶ Department of Urology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan.
⁷ Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁸ Department of Urology, China Medical University Hospital, Taichung, Taiwan.
⁹ School of Medicine, China Medical University, Taichung, Taiwan.
¹⁰ Department of Urology, China Medical University Beigang Hospital, Yunlin, Taiwan.
¹¹ Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
¹² Department of Urology, National Taiwan University Hospital, College of Medicine, and National Taiwan University, Taipei, Taiwan.
¹³ Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.
¹⁴ Department of Medicine, Mackay Medical College, Taipei, Taiwan.
¹⁵ Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁶ Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
¹⁷ Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
¹⁸ Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan.
¹⁹ Department of Nursing, College of Healthcare and Management, Asia Eastern University of Science and Technology, New Taipei City, Taiwan.
²⁰ General Education Center, Eastern University of Science and Technology, New Taipei City, Taiwan.
²¹ Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan.
²² Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
²³ College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
²⁴ Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.
²⁵ Department of Health and Nutrition Biotechnology, Asian University, Taichung, Taiwan.
²⁶ Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan.
²⁷ College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
²⁸ Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan.
²⁹ Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan.
³⁰ Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.
³¹ Chang Gung University of Science and Technology, Chia-Yi, Taiwan.
³² Department of Medicine, Chang Gung University, Taoyuan, Taiwan.
³³ Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
³⁴ Taipei Medical University Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan.
³⁵ Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
³⁶ Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan.
³⁷ Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung City, Taiwan.
³⁸ Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Abstract

Background: The advantage of adjuvant chemotherapy for upper urinary tract urothelial cancer (UTUC) has been reported, whereas its impact on upper tract cancer with variant histology remains unclear. We aimed to answer the abovementioned question with our real-world data.

Design setting and participants: Patients who underwent radical nephroureterectomy (RNU) and were confirmed to have variant UTUC were retrospectively evaluated for eligibility of analysis. In the Taiwan UTUC Collaboration database, we identified 245 patients with variant UTUC among 3,109 patients with UTUC who underwent RNU after excluding patients with missing clinicopathological information.

Intervention: Those patients with variant UTUC were grouped based on their history of receiving adjuvant chemotherapy or not.

Outcome measurements and statistical analysis: Propensity score matching was used to reduce the treatment assignment bias. Multivariable Cox regression model was used for the analysis of overall, cancer-specific, and disease-free survival.

Results and limitations: For the patients with variant UTUC who underwent adjuvant chemotherapy compared with those without chemotherapy, survival benefit was identified in overall survival in univariate analysis (hazard ratio (HR), 0.527; 95% confidence interval (CI), 0.285-0.973; p = 0.041). In addition, in multivariate analysis, patients with adjuvant chemotherapy demonstrated significant survival benefits in cancer-specific survival (OS; HR, 0.454; CI, 0.208-0.988; p = 0.047), and disease-free survival (DFS; HR, 0.324; 95% CI, 0.155-0.677; (p = 0.003). The main limitations of the current study were its retrospective design and limited case number.

Conclusions: Adjuvant chemotherapy following RNU significantly improved cancer-related survivals in patients with UTUC with variant histology.

Keywords: UTUC; adjuvant chemotherapy; nephroureterectomy; upper urinary tract urothelial cancer; variant histology.