新輔助化學治療合併淋巴結廓清手術改善上泌尿上皮癌之生存成績
王又德、吳錫金、楊啟瑞、黃志平、葉進仲、陳汶吉、張兆祥
中國醫藥大學附設醫院 泌尿部
Neoadjuvant chemotherapy combined with lymphadenectomy improves oncological outcomes of invasive upper urinary tract urothelial carcinoma
Yu-De Wang, Hsi-Chin Wu, Che-Rei Yang, Chi-Ping Huang, Chin-Chung Yeh, Wen-Chi Chen, Chao-Hsiang Chang
Department of Urology, China Medical University Hospital, Taichung, Taiwan,
Purpose:
The role of neoadjuvant chemotherapy and lymphadenectomy(LND) was still unclear. We compared the oncological outcomes of patients with invasive UTUC who received neoadjuvant chemotherapy and patients who did not.
Materials and Methods:
We conducted a retrospective study in patients who were diagnosed of UTUC with clinical stage at least T3 or N1 between April 2001 and August 2016. 78 patients who received nephroureterectomy and LND were included. Patients were divided into two groups according to the performance of neoadjuvant chemotherapy. The effects of neoadjuvant chemotherapy on oncological outcomes were assessed by Kaplan-Meier methods, the log-rank test and Cox proportional-hazards models. The mean follow-up duration was 26.9 months.
Results:
There were 19 patients who received neoadjuvant chemotherapy and 59 patients who did not. Among them 39 patients were man, mean±SD age was 68±11.9, and 53.8% were clinical stage III. Compared to control group, the patients in neoadjuvant group were younger (mean±SD age: 65±9.2, p=0.04), and the clinical stage was more advance (78.9% were clinical stage IV, p=0.001). There is no survival benefit in overall survival(OS) and recurrence free survival(RFS) with a 3-year OS rate of 70% and a 3-year RFS rate of 65%(p=0.5 and p=0.25). In subgroup analysis, neoadjuvant chemotherapy improved survival outcome of patients with clinical LN positive in 3-year RFS rate of 68% vs 25% (p<0.05).
Conclusion:
In our study, aggressive multimodality treatment including neoadjuvant chemotherapy and lymphadenectomy improved the oncological outcomes in the patient who was diagnosed LN positive UTUC.