Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy

Chih-Chin Yu; Chao-Hsiang Chang; Jen-Kai Fang; Steven K. Huang; Wen-Hsin Tseng; Hsiang-Ying Lee; Hsin-Chih Yeh; I-Hsuan Alan Chen; Jen-Tai Lin; Pi-Che Chen; Ian-Seng Cheong; Thomas Y. Hsueh; Yuan-Hong Jiang; Yu-Khun Lee; Wei-Chieh Chen; Shih-Hsiu Lo; Po-Hung Lin; Shian-Shiang Wang; Chao-Yuan Huang; Chia-Chang Wu; Jen-Shu Tseng; Shu-Yu Wu; Yao-Chou Tsai

Journal of the Formosan Medical Association (Dec 2023)

Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy

Chih-Chin Yu,
Chao-Hsiang Chang,
Jen-Kai Fang,
Steven K. Huang,
Wen-Hsin Tseng,
Hsiang-Ying Lee,
Hsin-Chih Yeh,
I-Hsuan Alan Chen,
Jen-Tai Lin,
Pi-Che Chen,
Ian-Seng Cheong,
Thomas Y. Hsueh,
Yuan-Hong Jiang,
Yu-Khun Lee,
Wei-Chieh Chen,
Shih-Hsiu Lo,
Po-Hung Lin,
Shian-Shiang Wang,
Chao-Yuan Huang,
Chia-Chang Wu,
Jen-Shu Tseng,
Shu-Yu Wu,
Yao-Chou Tsai

Affiliations

Chih-Chin Yu: Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
Chao-Hsiang Chang: Department of Urology, China Medical University and Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
Jen-Kai Fang: Department of Urology, China Medical University and Hospital, Taichung, Taiwan
Steven K. Huang: Division of Urology, Department of Surgery, Chi Mei Medical Center, Taiwan; Department of Medical Science Industries, College of Health Sciences, Chang Jung Christian University, Tainan City, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
Wen-Hsin Tseng: Division of Urology, Department of Surgery, Chi Mei Medical Center, Taiwan
Hsiang-Ying Lee: School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Hsin-Chih Yeh: School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
I-Hsuan Alan Chen: Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Taiwan
Jen-Tai Lin: Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Taiwan
Pi-Che Chen: Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
Ian-Seng Cheong: Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
Thomas Y. Hsueh: Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taiwan; Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
Yuan-Hong Jiang: Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
Yu-Khun Lee: Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
Wei-Chieh Chen: Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
Shih-Hsiu Lo: Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
Po-Hung Lin: Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
Shian-Shiang Wang: Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan
Chao-Yuan Huang: Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Chia-Chang Wu: Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
Jen-Shu Tseng: Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan; Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
Shu-Yu Wu: Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
Yao-Chou Tsai: Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan; Corresponding author. Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan.

Journal volume & issue: Vol. 122, no. 12
pp. 1274 – 1281

Abstract

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Purpose: The purpose of this study is to evaluate the rates of pathological complete response (ypT0N0/X) and pathological response (ypT1N0/X or less) in patients with upper tract urothelial cancer who were treated with neo-adjuvant chemotherapy and to examine their impact on oncological outcomes. Methods: This study is a multi-institutional retrospective analysis of patients with high-risk upper tract urothelial cancer who underwent neoadjuvant chemotherapy and radical nephroureterectomy between 2002 and 2021. Logistic regression analyses were used to investigate all clinical parameters for response after neoadjuvant chemotherapy. Cox proportional hazard models were performed to assess the effect of the response on the oncological outcomes. Results: A total of 84 patients with UTUC who received neo-adjuvant chemotherapy were identified. Among them, 44 (52.4%) patients received cisplatin-based chemotherapy, and 22 (26.2%) patients had a carboplatin-based regimen. The pathological complete response rate was 11.6% (n = 10), and the pathological response rate was 42.9% (n = 36). Multifocal tumors or tumors larger than 3 cm significantly reduced the odds of pathological response. In the multivariable Cox proportional hazard model, pathological response was independently associated with better overall survival (HR 0.38, p = 0.024), cancer-specific survival (HR 0.24, p = 0.033), and recurrence-free survival (HR 0.17, p = 0.001), but it was not associated with bladder recurrence-free survival (HR 0.84, p = 0.69). Conclusion: Pathological response after neo-adjuvant chemotherapy and radical nephroureterectomy is strongly associated with patient survival and recurrence, and it might be a good surrogate for evaluating the efficacy of neo-adjuvant chemotherapy in the future.

Published in Journal of the Formosan Medical Association

ISSN: 0929-6646 (Print)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Medicine (General)
Website: http://www.journals.elsevier.com/journal-of-the-formosan-medical-association/

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