前輔助性與輔助性化學治療用於上泌尿道泌尿上皮癌之病人
方仁愷、張議徽、張兆祥、黃志平、楊啟瑞、陳汶吉、葉進仲、連啟舜、陳冠亨、蕭博任、吳錫金、謝博帆、李宗睿、張英傑、林精湛1、林哲弘1、葉士芃1
中國醫藥大學附設醫院 泌尿部，1腫瘤部
Neoadjuvant chemotherapy and adjuvant chemotherapy for locally advanced upper tract urothelial carcinoma
Jen Kai Fang, Yi-Huei Chang, Chao-Hsiang Chang, Chi-Rei Yang, Wen-Chi Chen, Chin-Chung Yeh, Chi-Shun Lien, Guang-Heng Chen, Po-Jen Hsiao, Hsi-Chin Wu, Po-Fan Hsieh, Tzung-Ruei Li, Ying-Chieh Chang, Ching-Chan Lin1, Che-Hung Lin1, Shih-Peng Yeh1, Chi-Ping Huang
Department of Urology and 1Oncology, China Medical University Hospital, Taichung, Taiwan
Purpose: Perioperative chemotherapy is commonly used for locally advanced upper tract urothelial carcinoma(UTUC). Due to limited evidence of the neoadjuvant chemotherapy benefit for UTUC and lack of a tool for preoperative clinical staging, the indication of neoadjuvant chemotherapy is controversial. The aim of this study was to evaluate the outcomes of perioperative chemotherapy for locally advanced UTUC in China Medical University Hospital.
Materials and Methods: We retrospectively reviewed patients with locally advanced UTUC (clinical stage III, IV or pathological stage III, IV) receiving nephroureterectomy and perioperative chemotherapy. Overall survival(OS), cancer-specific survival(CSS) and recurrence-free survival(RFS) were compared between the neoadjuvant chemotherapy group and adjuvant chemotherapy group.
Results: Between June 2003 and July 2018, 261 patients with locally advanced UTUC underwent nephroureterectomy. The median follow time was 36.5 months. 98 patients (37.5%) received adjuvant chemotherapy and 19 patients (7.2%) received neoadjuvant chemotherapy. Among the neoadjuvant group, most of the patients (78.9%) had clinical stage IV UTUC. The pathological stage of 5 patients turned to stage 0a to II. Comparing the oncological outcomes of stage IV patients between the neoadjuvant chemotherapy group and adjuvant chemotherapy group, there was no significant difference in OS, CSS and RFS.
Conclusions: In this case series, most of the patients in the neoadjuvant chemotherapy group had late-stage UTUC when diagnosed. Neoadjuvant chemotherapy or not had little impact on survival in this situation. However, neoadjuvant chemotherapy had the potential to downstage and these patients had better survival.