Risk Stratification Model to Predict High-Risk Patients for Adjuvant Chemotherapy in Upper Urinary Tract Urothelial CancerKazuhiro Nagao1*, Hideyasu Matsuyama1, Kiyohide Fujimoto2, Haruhito Azuma3, Hiroaki Shiina4, Shigeru Sakano1, Yoshihiro Tatsumi2, Teruo Inamoto3 and Hiroaki Yasumoto1
- *Corresponding Author:
- Kazuhiro Nagao
Department of Urology, Graduate School of Medicine
Yamaguchi University 1-1-1, Minami-Kogushi, Ube
755-0046, Yamaguchi, Japan
E-mail: [email protected]
Received date: January 22, 2017; Accepted date: January 31, 2017; Published date: February 05, 2017
Citation: Nagao K, Matsuyama H, Fujimoto K, Azuma H, Shiina H, et al. (2017) Risk Stratification Model to Predict High-Risk Patients for Adjuvant Chemotherapy in Upper Urinary Tract Urothelial Cancer. Chemo Open Access 6:220. doi: 10.4172/2167-7700.1000221
Copyright: © 2017 Nagao K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objective: Optimal patient selection for adjuvant chemotherapy has not been clarified in upper urinary tract urothelial cancer (UTUC). We aimed to develop a risk model to select candidates for adjuvant chemotherapy after radical nephroureterectomy (RNU).
Methods: A retrospective review of 936 patients with UTUC between 1995 and 2015 who received ≥ 2 cycles of platinum-based adjuvant chemotherapy after RNU (n=213) or surgery alone (n=723) was conducted in collaborative institutions. Risk factors for cancer-specific mortality were extracted using the proportional hazard model. The survival benefit in high-risk patients was compared between the groups.
Results: At a median follow-up of 1006 days (34 months), disease recurrence, cancer-specific mortality, and allcause mortality were noted in 253 (27.5%), 206 (22.0%), and 285 (30.4%) patients, respectively. On multivariate analysis, baseline serum C-reactive protein (CRP) ≥ 0.32 mg/dL (HR: 1.74, 95% CI: 1.09–2.75, p=0.0201), pathologic T stage ≥ 3 (pT>3) (HR: 2.17, 95% CI: 1.28–3.76, (p=0.0033), cN+ (HR: 2.84, 95% CI: 1.50–5.01, p=0.0021), and lymphovascular invasion (LVI) (HR: 3.94, 95% CI: 2.23–7.17, p<0.0001) were independent predictors of cancer-specific mortality (CSM) in the training set. When they were used to categorize patients into low (0-1 factor) and high-risk groups (2-4 factors), high-risk patients had significantly worse CSM than those with low-risk. In the high-risk patients, 42.3% who received adjuvant chemotherapy had significantly better CSM and all-cause mortality than those who underwent surgery alone. In high-risk patients, multivariate analysis showed adjuvant chemotherapy as an independent prognostic factor for CSM (HR: 0.52) and all-cause mortality (HR: 0.57).
Conclusion: CRP, pT>3, cN+, and LVI was useful for identifying high-risk patients.