Effectiveness Of Adjuvant Chemotherapy After Radical Nephroureterectomy For Upper Tract Urothelial Carcinoma

PurposeTo evaluate the efficacy of adjuvant systemic chemotherapy for upper tract urothelial carcinoma?UTUC?after radical nephroureterectomy?RNU?.MethedsWe retrospectively reviewed the medical records of 107 patients with pT_3-4N₀M₀ UTUC who had undergone radical nephroureterectomy between 2009 and 2017 at Shandong Provincial Hospital.The patients were divided into two groups:those who received adjuvant chemotherapy?AC group?and those who did not?surgery-alone:SA?.A chi-squared was used for categorical variables between the two groups;Outcomes were measured by recurrence-free survival?RFS?and overall survival?OS?based on chemotherapy status between the cohorts.Survival was calculated using the Kaplan-Meier method and compared using a log-rank test;Cox proportional hazards regression models addressed the associations between clinical factors and RFS and OS.Results46 out of the 107 patients underwent two to four cycles of adjuvant chemotherapy after nephroureterectomy.Median follow-up was 48.6 months.There were no significant differences in the background characteristics of the two groups.Recurrence developed in 19?41.3%?and 31?50.8%?patients in the AC and SA groups,respectively.Ultimately,17?36.90%?and 28?45.9%?patients in the AC and SA groups died.The 3 and 5 year RFS rates were 50.9%and 39.6%for the non-adjuvant chemotherapy group versus 62.7%and4108%for the adjuvant chemotherapy group?p=0.211,log-rank test?.OS rates for the same time period were 54.0%and 35.9%for the non-adjuvant chemotherapy group versus 53.5%and 44.1%for the adjuvant chemotherapy group?p=0.500,log-rank test?.On multivariate analysis,adjuvant chemotherapy could not predict RFS and OS after surgery.When patients who received cisplatin-based adjuvant chemotherapy?n=46?were compared to those who did not receive adjuvant chemotherapy,similar results were found.ConclusionThere does not appear to be a significant RFS or OS benefit associated with adjuvant chemotherapy.Prospective randomized clinical trials are necessary to verify the effect of adjuvant chemotherapy on locally advanced UTUC.