Podium 01
最初無法手術治療的上尿路泌尿上皮癌中的前輔助治療與輔助治療的比較研究
黃昱凱1, 黃逸修1,3,4, 林登龍1,3,4,
張延驊1,3,4, 鍾孝仁1,3,4, 林子平1,3,4, 林志杰1,3,4, 陳威任1,3,4, 顧明軒1,3,4, 黃志賢 1,3,4, 顏厥全2, 張牧新2, 賴峻毅2
1泌尿部, 2腫瘤醫學部, 台北榮民總醫院
3書田泌尿科學研究中心
4國立陽明交通大學醫學院泌尿學科
Neoadjuvant Therapy in Initially Inoperable Upper Tract Urothelial Carcinoma – A Comparative Study with Adjuvant Strategies
Yu-Kai Huang1, Eric Yi-Hsiu Huang1,3,4, Alex Tong-Long Lin1,3,4,
Yen-Hwa Chang1,3,4, Hsiao-Jen Chung1,3,4, Tzu-Ping Lin1,3,4, Chih-Chieh Lin1,3,4, Wei-Jen Chen1,3,4, Ming-Hsuan Ku1,3,4, William JS Huang 1,3,4, Chueh-Chuan Yen2, Peter Mu-Hsin Chang2, Jiun-I Lai2
1Department of Urology, 2Department of Oncology, Taipei Veterans General Hospital
3Department of Urology, School of Medicine and Shu-Tien Urological Science Research Center, 4National Yang Ming Chiao Tung University, Taipei, Taiwan
Purpose: Upper tract urothelial carcinoma (UTUC) presents a significant clinical challenge due to its heightened aggressiveness when compared to bladder cancer. While surgical intervention is the standard treatment for localized disease, the role of neoadjuvant therapy in managing locally advanced UTUC remains less explored.
Materials and Methods: Between 2010 and 2021, we conducted a retrospective study in 70 patients with locally advanced UTUC. Among them, 25 patients were initially deemed inoperable due to the local aggressiveness of their tumors. These individuals underwent neoadjuvant therapies, which included gemcitabine-cisplatin (GC) (60.0%, 15/25), gemcitabine-carboplatin (GCa) (12.0%, 3/25), and other regimens (28.0%, 7/25). Radical nephroureterectomy and bladder cuff excision (RNU BCE) was possible after neoadjuvant therapies with aforementioned treatment, forming the neoadjuvant group. Another 45 patients underwent RNU BCE as their initial treatment, followed by adjuvant therapy with either GC or GCa regimen, forming the adjuvant group. We collected data on follow-up duration, mortality, progression time, pathologic complete response (pCR) defined as ypT0N0M0, and pathologic downstaging while the clinical AJCC stage was higher than the pathologic AJCC stage. Overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) were compared between the neoadjuvant group and the adjuvant group using a Cox regression model.
Results: Among the 70 patients, 32 (45.7%) were male, and 38 (54.3%) were female, with a mean age of 71.20 years (range 50-87 years). The median follow-up time was 30.5 months. Notably, ypT0N0M0 was achieved in 4 patients (16.0%), and 15 patients (60.0%) experienced pathologic downstaging in the neoadjuvant group. Cox regression analysis showed no significant difference in OS (HR=1.024, 95% CI: 0.45-2.31, p=0.955), CSS (HR=0.985, 95% CI: 0.41-2.35, p=0.972), and PFS (HR=0.91, 95% CI: 0.45-1.83, p=0.79) between neoadjuvant and adjuvant group. Within the neoadjuvant subgroup, those who received either GC or GCa regimen were further analyzed (18 patients), Cox regression analysis showed no significant difference in OS (HR=1.28, 95% CI: 0.51-3.20, p=0.597), CSS (HR=1.13, 95% CI: 0.42-3.06, p=0.809), and PFS (HR=0.771, 95% CI: 0.34-1.77, p=0.54) between the two groups.
Conclusions:
For those who initially presented with locally advanced inoperable UTUC, neoadjuvant therapy has shown the potential to render these patients amenable to surgical intervention in our experience. We also observed complete pathologic responses in a substantial proportion of patients. Moreover, comparable survival outcomes, including OS, CSS, and PFS were noted when compared to those who underwent adjuvant therapy following surgery.