714 844
Brief Correspondence
Efficacy of Systemic Chemotherapy Plus Radical
Nephroureterectomy for Metastatic Upper Tract Urothelial
Carcinoma
Thomas Seisen
a ,Tarun Jindal
a ,Patrick Karabon
a ,Akshay Sood
a ,Joaquim Bellmunt
b ,Morgan Roupreˆt
c ,Jeffrey J. Leow
d ,Malte W. Vetterlein
a ,Maxine Sun
d ,Shaheen Alanee
a ,Toni K. Choueiri
b ,Quoc-Dien Trinh
d ,Mani Menon
a ,Firas Abdollah
a , *a
Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA;
b
Department of Medical
Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA;
c
Department of Urology, Pitie´ Salpe´trie`re Hospital, Assistance Publique
des Hoˆpitaux de Paris, Pierre and Marie Curie University, Paris, France;
d
Division of Urological Surgery and Center for Surgery and Public Health, Brigham
and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Approximately 10% of patients with upper tract urothelial
carcinoma (UTUC) present with involvement of extraregio-
nal lymph nodes and/or other distant sites at initial diagnosis
[1] .Although it can vary tremendously according to
baseline characteristics
[2] ,prognosis for these individuals
is ominous, as 3-yr overall survival (OS) rates for metastatic
UTUC (mUTUC) do not exceed 10%
[1] .Cisplatin-based combination chemotherapy alone is
currently considered the standard of care for fit patients
with mUTUC
[3] .Nonetheless, the paradigm for treating
E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) 7 1 4 – 7 1 8available at
www.scienced irect.comjournal homepage:
www.europeanurology.comArticle info
Article history:
Accepted November 9, 2016
Associate Editor:
Giacomo Novara
Keywords:
Urothelial carcinoma
Ureteral neoplasms
Ureter
Renal pelvis
Drug therapy
Propensity score
Survival
Abstract
Given the growing body of evidence supporting the benefit of primary tumor control for
a wide range of metastatic malignancies, we hypothesized that chemotherapy plus
radical nephroureterectomy (RNU) is associated with an overall survival (OS) benefit
compared to chemotherapy alone for metastatic upper tract urothelial carcinoma
(mUTUC). Within the National Cancer Data Base (2004–2012), we identified 398
(38.4%) and 637 (61.6%) patients who received chemotherapy plus RNU and chemo-
therapy alone, respectively. Inverse probability of treatment weighting (IPTW)-adjusted
Kaplan-Meier curves showed that 3-yr OS was 16.2% (95% confidence interval [CI] 12.1–
20.3) for chemotherapy plus RNU and 6.4% (95%CI 4.1–8.7) for chemotherapy alone
(
p
<
0.001). In IPTW-adjusted Cox regression analysis, chemotherapy plus RNU was
associated with a significant OS benefit (hazard ratio 0.70, 95% CI 0.61–0.80;
p
<
0.001).
Despite the usual biases related to the observational study design, our findings show a
net OS benefit for fit patients who received chemotherapy plus RNU for mUTUC relative
to their counterparts treated with chemotherapy alone.
Patient summary:
We examined the role of radical nephroureterectomy in addition to
systemic chemotherapy for metastatic upper tract urothelial carcinoma. We found that
such treatment may be associated with an overall survival benefit compared to che-
motherapy alone in fit patients.
#
2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.
* Corresponding author. Vattikuti Urology Institute, Henry Ford Hospital, 2799 West Grand Boule-
vard, Detroit, MI 48202, USA. Tel. +1 348 7357124; Fax: +1 313 9169539.
E-mail address:
firas.abdollah@gmail.com(F. Abdollah).
http://dx.doi.org/10.1016/j.eururo.2016.11.0120302-2838/
#
2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.