Survival Benefit Reported With Adjuvant Chemotherapy After Nephroureterectomy for Urothelial Carcinoma
In a National Cancer Database analysis reported in the Journal of Clinical Oncology, Seisen et al found that adjuvant chemotherapy after radical nephroureterectomy was associated with an overall survival benefit in patients with locally advanced or regional lymph node–positive upper tract urothelial carcinoma.
Study Details
The study involved 3,253 patients in the National Cancer Database from 2004 to 2012 who received adjuvant chemotherapy (n = 762; 23.4%) or observation (n = 2,491; 76.6%) after radical nephroureterectomy for pT3/T4 or pN-positive upper tract urothelial carcinoma. Inverse probability of treatment weighting–adjusted Kaplan-Meier analysis and Cox proportional hazards regression analysis were used to compare overall survival in the two groups.
Improved Overall Survival
Inverse probability of treatment weighting–adjusted Kaplan-Meier curves showed that median overall survival was 47.41 months (interquartile range = 19.88–112.39 months) in the adjuvant therapy group vs 35.78 months (interquartile range = 14.09–99.22) in the observation group (P < .001). The 5-year inverse probability of treatment weighting–adjusted overall survival rates were 43.90% vs 35.85%.
On inverse probability of treatment weighting–adjusted Cox proportional hazards regression analysis, the hazard ratio for death for adjuvant therapy vs observation was 0.77 (P < .001). The overall survival benefit was consistent across all subgroups examined (all P < .05), with no significant heterogeneity of treatment effect detected.
The investigators concluded: “We report an [overall survival] benefit in patients who received [adjuvant chemotherapy] versus observation after [radical nephroureterectomy] for pT3/T4 and/or pN+ [upper tract urothelial carcinoma]. Although our results are limited by the usual biases related to the observational study design, we believe that the present findings should be considered when advising post-[radical nephroureterectomy] management of advanced [upper tract urothelial carcinoma], pending level I evidence.”
The study was supported by a grant from the Vattikuti Urology Institute, an award from the Conquer Cancer Foundation of ASCO, and an award from the Prostate Cancer Foundation.
Steven Lee Chang, MD, of Brigham and Women’s Hospital, is the corresponding author of the Journal of Clinical Oncology article.
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