Neoadjuvant and adjuvant chemotherapy use in upper tract urothelial carcinoma

Andrew Cohen, Kristine Kuchta, Sangtae Park

Research output: Contribution to journalArticle

Abstract

Objective To determine trends in neoadjuvant and adjuvant chemotherapy use for upper tract urothelial cancer and assess its effects on survival. Materials and methods We identified all patients diagnosed with upper tract urothelial cancer who underwent surgical treatment in the SEER-Medicare database from 2002 to 2011. We collected and analyzed patient demographic, clinical, and pathologic characteristics. We strictly defined neoadjuvant and adjuvant chemotherapy and studied patients who met such criteria. Multivariable Cox proportional hazards models identified were used to identify independent predictors of overall and cancer-specific survival. Results A total of 3,432 patients met inclusion criteria, and their median age was 77 years. Overall, 86.4% of patients underwent surgery alone, 1.8% received neoadjuvant chemotherapy plus surgery, and 11.8% underwent surgery and adjuvant chemotherapy. Neoadjuvant chemotherapy use increased during the study period. Gemcitabine, carboplatin, cisplatin, and paclitaxel were the most commonly used agents. Cancer-specific survival at 5 years was 65.0% (95% CI: 63.2%–66.8%). Cox proportional hazards modeling controlling for sex, race, year of diagnosis, location, and pathologic stage revealed that higher pathologic nodal stage, tumor size>3 cm, increased age, and carcinoma in situ predicted for worse survival. Conclusion Age, nodal stage, and tumor size>3 cm predict for worse cancer-specific survival. Neoajduvant chemotherapy is underused.

Original languageEnglish (US)
Pages (from-to)322-327
Number of pages6
JournalUrologic Oncology: Seminars and Original Investigations
Volume35
Issue number6
DOIs
StatePublished - Jun 2017
Externally publishedYes

Keywords

  • Chemotherapy
  • Neoadjuvant
  • Nephroureterectomy
  • SEER-medicare
  • Upper tract transitional cell carcinoma
  • Upper tract urothelial cancer

ASJC Scopus subject areas

  • Oncology
  • Urology

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