The Impact Of Perioperative Chemotherapy On The Survival Of Patients With Muscle Invasive Non-metastatic Upper Urinary Tract Urothelial Carcinoma

Objective: At present,it’s still controversial that the survival value of neoadjuvant chemotherapy and adjuvant chemotherapy for patiens of muscle invasive non-metastatic upper urinary tract urothelial carcinoma(UTUC).Moreover,domestic and foreign relevant clinical studies for UTUC are rare,especially prospective clinical randomized studies.Therefore,this study evaluated the effect of radical nephroureterectomy(RNU)and perioperative chemotherapy on the survival of muscle invasive non-metastatic UTUC patients based on the Surveillance,Epidemiology,and End Results(SEER)database,so as to provide a new evidence for urology clinicians to make treatment decision.Methods: The relevant clinicopathological data of patients with muscle invasive non-metastatic UTUC who underwent radical nephroureterectomy(RNU)and met the inclusion criteria were selected from the SEER database.The included patients were divided into perioperative chemotherapy and RNU groups,and multivariable logistic regression models was used to analyze the independent influencing factors of patiens’ choice of perioperative chemotherapy.Cox regression model were used to analyze the 5-year overall survival(OS)and cancer-specific survival(CSS)of two groups of patiens.Finally,propensity score matching(PSM)was performed using adjusting two groups of patiens,and Kaplan-Meier curve and multivariable Cox regression model were used to analyze the 5-year OS and CSS of matched two groups of patiens,respectively.Results: A total of 1022 patients with muscle invasive non-metastatic UTUC were included,of which 753 chose RNU only,and 269 chose perioperative chemotherapy.Multivariable logistic regression analysis showed that the worse the pathology grade(poorly differentiated: OR:2.72;95% CI:1.22-6.75;P=0.02/undifferentiated: OR: 3.47;95% CI: 1.67-8.21;P=0.002)、the deeper the tumor invasion(T3: OR:2.75;95% CI: 1.84-4.21;P<0.001/T4: OR:2.90;95% CI: 1.50-5.51;P=0.001)、regional lymph node-positve(OR: 3.18;95% CI: 2.07-4.89;P<0.001)and tumor in the uretre(OR: 1.49;95% CI:1.05-2.11;P=0.03)both indicate that patiens more likely to choose perioperative chemotherapy,but age over 64 years old(OR: 0.34;95% CI:0.24-0.48;P<0.001)indicates that patients are less likely to choose perioperative chemotherapy.Univariable Cox regression model found that the 5-year OS(HR: 0.75;95% CI:0.60-0.94;P=0.01)of perioperative chemotherapy group was significantly higher than that of RNU group,but difference in the 5-year CSS between two groups was not statistically significant(HR: 0.81;95% CI: 0.63-1.03;P=0.09).Moreover,in multivariable Cox regression model,the 5-year OS(HR: 0.62;95% CI: 0.49-0.80;P<0.001)and CSS(HR: 0.67;95% CI: 0.51-0.87;P=0.003)of perioperative chemotherapy group was significantly higher than those of RNU group.After PSM,Kaplan-Meier curve showed that the 5-year OS(P=0.023)of perioperative chemotherapy group was significantly better than that of RNU group,but difference in the 5-year CSS between two groups was not statistically significant(P=0.084).Further Multivariable Cox regression analysis manifested that the 5-year OS(HR: 0.60;95% CI: 0.45-0.79;P<0.001)and CSS(HR: 0.61;95% CI: 0.45-0.83;P=0.002)of perioperative chemotherapy group was significantly higher than those of RNU group.Conclusions: 1.Compare with RNU alone,perioperative chemotherapy was more beneficial to the OS and CSS of patients with muscle invasive non-metastatic UTUC.2.Age,tumor site,pathology grade and pathological stage(T and N)were independent factors influencing the choice of perioperative chemotherapy for patients with muscle invasive non-metastatic UTUC.