Impact of Adjuvant Gemcitabine Containing Chemotherapy Following Radical Nephroureterectomy for Patients with Upper Tract Urothelial Carcinoma: Results from a Propensity-Score Matched Cohort Study

Zhao Hongda; Liu Kang; Chi-Fai Ng; Jean de la Rosette; Pilar Laguna; Paolo Gontero; Joyce Baard; Ozcan Yildiz; Jeremy Yuen-Chun Teoh

doi:10.3233/BLC-230041

Impact of Adjuvant Gemcitabine Containing Chemotherapy Following Radical Nephroureterectomy for Patients with Upper Tract Urothelial Carcinoma: Results from a Propensity-Score Matched Cohort Study

Bladder Cancer. 2023 Sep 25;9(3):217-226. doi: 10.3233/BLC-230041. eCollection 2023.

Authors

Zhao Hongda¹, Liu Kang¹, Chi-Fai Ng¹, Jean de la Rosette², Pilar Laguna², Paolo Gontero³, Joyce Baard⁴, Ozcan Yildiz⁵, Jeremy Yuen-Chun Teoh¹

Affiliations

¹ Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China.
² Department of Urology, Medipol Mega Hospital, Istanbul Medipol University, Istanbul, Turkey.
³ University of Turin, Molinette Hospital, Turin, Italy.
⁴ Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
⁵ Department of Medical Oncology, Istanbul Medipol University, Istanbul, Turkey.

Abstract

Background: The evidence regarding perioperative adjuvant chemotherapy and personalized surveillance strategies for upper tract urothelial carcinoma is limited.

Objective: To evaluate whether adjuvant gemcitabine containing chemotherapy affects the oncological outcomes of advanced upper tract urothelial carcinoma (UTUC).

Methods: The CROES-UTUC registry is an observational, international, multi-center study on patients diagnosed with UTUC. Patient and disease characteristics from 2380 patients with UTUC were collected, and finally 738 patients were included in this analysis. The primary outcome of this study was recurrence-free survival. Propensity score matching was performed. Kaplan-Meier and multivariate Cox regression analyses were performed by stratifying patients according to the treatment of adjuvant chemotherapy.

Results: A total of 738 patients were included in this analysis, and 59 patients received adjuvant chemotherapy (AC), including 50 patients who received gemcitabine. A propensity score matching was performed, including 50 patients who received gemcitabine containing treatment and 50 patients without adjuvant chemotherapy. Disease recurrence occurred in 34.0% of patients. The recurrence rate in the AC group was 22.0%, which was significantly lower than the non-AC group (46.0%). Kaplan-Meier analyses also showed that AC was associated with a lower likelihood of tumor recurrence (p = 0.047). However, AC was not significantly associated with a higher overall survival (OS) (p = 0.908) and cancer-specific survival (CSS) (p = 0.979). Upon multivariate Cox regression analysis, AC was associated with a lower risk of tumor recurrence (HR = 0.297, p = 0.028).

Conclusion: The present study confirms that adjuvant gemcitabine containing chemotherapy could decrease the risk of tumor recurrence in patients with locally advanced UTUC following nephroureterectomy. However, more studies are need to draw a clearer image of the value of this treatment method.

Keywords: Adjuvant chemotherapy; gemcitabine; nephroureterectomy; outcome assessment; urothelial carcinoma.