670 HIGH RATES OF ADVANCED DISEASE, COMPLICATIONS, AND DECLINE OF RENAL FUNCTION AFTER RADICAL NEPHROURETERECTOMY: FURTHER EVIDENCE TO SUPPORT THE INCREASED USE OF NEOADJUVANT CHEMOTHERAPY? (2011)

You have accessJournal of UrologyUrothelial Cancer: Upper Tract Tumors1 Apr 2011670 HIGH RATES OF ADVANCED DISEASE, COMPLICATIONS, AND DECLINE OF RENAL FUNCTION AFTER RADICAL NEPHROURETERECTOMY: FURTHER EVIDENCE TO SUPPORT THE INCREASED USE OF NEOADJUVANT CHEMOTHERAPY? Jay Raman, Yu-Kuan Lin, Matthew Kaag, Timothy Atkinson, Paul Crispen, Chad Reichard, Scott Eggener, Mark Hockenberry, Thomas Guzzo, Benoit Peyronnet, Karim Bensalah, Jay Simhan, Alexander Kutikov, Eugene Cha, Michael Herman, Douglas Scherr, Shahrokh Shariat, and Stephen Boorjian Jay RamanJay Raman Hershey, PA More articles by this author , Yu-Kuan LinYu-Kuan Lin Hershey, PA More articles by this author , Matthew KaagMatthew Kaag Hershey, PA More articles by this author , Timothy AtkinsonTimothy Atkinson Lexington, KY More articles by this author , Paul CrispenPaul Crispen Lexington, KY More articles by this author , Chad ReichardChad Reichard Chicago, IL More articles by this author , Scott EggenerScott Eggener Chicago, IL More articles by this author , Mark HockenberryMark Hockenberry Philadelphia, PA More articles by this author , Thomas GuzzoThomas Guzzo Philadelphia, PA More articles by this author , Benoit PeyronnetBenoit Peyronnet Rennes, France More articles by this author , Karim BensalahKarim Bensalah Rennes, France More articles by this author , Jay SimhanJay Simhan Philadelphia, PA More articles by this author , Alexander KutikovAlexander Kutikov Philadelphia, PA More articles by this author , Eugene ChaEugene Cha New York, NY More articles by this author , Michael HermanMichael Herman New York, NY More articles by this author , Douglas ScherrDouglas Scherr New York, NY More articles by this author , Shahrokh ShariatShahrokh Shariat New York, NY More articles by this author , and Stephen BoorjianStephen Boorjian Rochester, MN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1600AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical nephroureterectomy (RNU) alone is inadequate treatment for a significant proportion of patients with advanced stage (pT3/pT4 or lymph node positive) upper-tract urothelial carcinoma (UTUC). We reviewed a multi-institutional cohort of patients managed by RNU to identify the incidence and oncologic outcomes of pathologically advanced disease as well as utilization of adjuvant chemotherapy (AC) regimens. METHODS A retrospective review of institutional databases from 7 academic centers identified 414 patients who underwent RNU without neoadjuvant chemotherapy. Median follow-up was 16 months (range, 1–120). The Modification of Diet in Renal Disease (MDRD) equation was used to estimate pre- and postoperative glomerular filtration rate (eGFR). The modified Clavien system was used to classify perioperative complications. Logistic regression determined factors associated with cancer survival. RESULTS Overall, 256 men and 158 women with a median age of 70 years were included. On final pathology, 177 patients (43%) had advanced stage disease, including 118 who were pT3N0, 13 with pT4N0 tumors, and 46 who were pTanyN+. Mean eGFR for these 177 patients declined from 59 preoperatively to 51 ml/min/1.73m2 (p<0.001) following RNU, with 3 patients becoming dialysis-dependent. Perioperative complications occurred in 46 of 177 (26%) patients with advanced UTUC, including 22% Grade I, 52% Grade II, 15% Grade III, and 11% Grade IV. Only 55 of these 177 patients (31%) received AC, and in particular only 17% (2 of 12) who experienced a perioperative Clavien III or IV complication received AC. On multivariate analysis, increasing age (HR 1.4, p=0.03), positive surgical margins (HR 2.1, p=0.01), and positive lymph nodes (HR 4.3, p<0.001) predicted death from UTUC, while receipt of adjuvant chemotherapy (HR 0.85, p=0.05) was associated with a decreased risk of cancer-specific mortality. CONCLUSIONS Over 40% of patients managed by RNU had locally advanced cancers (pT3/pT4 or +LN) at time of surgery. Only 31% of these patients, however, received AC. Perioperative decline in post-operative GFR, as well as a complication rate of approximately 25%, may have contributed to the underutilization of AC. Despite heterogenous regimens, receipt of AC did provide a survival benefit for patients with advanced UTUC. Collectively, such data underscores the potential benefit for neoadjuvant chemotherapy in appropriately selected patients with UTUC. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e271 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jay Raman Hershey, PA More articles by this author Yu-Kuan Lin Hershey, PA More articles by this author Matthew Kaag Hershey, PA More articles by this author Timothy Atkinson Lexington, KY More articles by this author Paul Crispen Lexington, KY More articles by this author Chad Reichard Chicago, IL More articles by this author Scott Eggener Chicago, IL More articles by this author Mark Hockenberry Philadelphia, PA More articles by this author Thomas Guzzo Philadelphia, PA More articles by this author Benoit Peyronnet Rennes, France More articles by this author Karim Bensalah Rennes, France More articles by this author Jay Simhan Philadelphia, PA More articles by this author Alexander Kutikov Philadelphia, PA More articles by this author Eugene Cha New York, NY More articles by this author Michael Herman New York, NY More articles by this author Douglas Scherr New York, NY More articles by this author Shahrokh Shariat New York, NY More articles by this author Stephen Boorjian Rochester, MN More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...