Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy
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. Me...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-12-01
|
| Series: | Journal of the Formosan Medical Association |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664623002309 |
| _version_ | 1797399253347205120 |
|---|---|
| author | 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 |
| author_facet | 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 |
| author_sort | Chih-Chin Yu |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-09T01:36:42Z |
| format | Article |
| id | doaj.art-ef111c5f25834a54a05eead9b088e9df |
| institution | Directory Open Access Journal |
| issn | 0929-6646 |
| language | English |
| last_indexed | 2024-03-09T01:36:42Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj.art-ef111c5f25834a54a05eead9b088e9df2023-12-09T06:04:21ZengElsevierJournal of the Formosan Medical Association0929-66462023-12-011221212741281Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapyChih-Chin Yu0Chao-Hsiang Chang1Jen-Kai Fang2Steven K. Huang3Wen-Hsin Tseng4Hsiang-Ying Lee5Hsin-Chih Yeh6I-Hsuan Alan Chen7Jen-Tai Lin8Pi-Che Chen9Ian-Seng Cheong10Thomas Y. Hsueh11Yuan-Hong Jiang12Yu-Khun Lee13Wei-Chieh Chen14Shih-Hsiu Lo15Po-Hung Lin16Shian-Shiang Wang17Chao-Yuan Huang18Chia-Chang Wu19Jen-Shu Tseng20Shu-Yu Wu21Yao-Chou Tsai22Division 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, TaiwanDepartment of Urology, China Medical University and Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, TaiwanDepartment of Urology, China Medical University and Hospital, Taichung, TaiwanDivision 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, TaiwanDivision of Urology, Department of Surgery, Chi Mei Medical Center, TaiwanSchool 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, TaiwanSchool 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, TaiwanDivision of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, TaiwanDivision of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, TaiwanDepartment of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, TaiwanDepartment of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, TaiwanDivision of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taiwan; Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanDepartment of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, TaiwanDepartment of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, TaiwanDepartment of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, TaiwanDepartment of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, TaiwanDivision 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, TaiwanDivision 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, TaiwanDepartment of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, TaiwanDepartment of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, TaiwanDepartment of Urology, MacKay Memorial Hospital, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan; Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, TaiwanDivision 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, TaiwanDivision 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.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.http://www.sciencedirect.com/science/article/pii/S0929664623002309ChemotherapyNeo-adjuvantOncological outcomesUpper tract urothelial cancer |
| spellingShingle | 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 Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy Journal of the Formosan Medical Association Chemotherapy Neo-adjuvant Oncological outcomes Upper tract urothelial cancer |
| title | Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy |
| title_full | Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy |
| title_fullStr | Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy |
| title_full_unstemmed | Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy |
| title_short | Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy |
| title_sort | impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo adjuvant chemotherapy |
| topic | Chemotherapy Neo-adjuvant Oncological outcomes Upper tract urothelial cancer |
| url | http://www.sciencedirect.com/science/article/pii/S0929664623002309 |
| work_keys_str_mv | AT chihchinyu impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT chaohsiangchang impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT jenkaifang impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT stevenkhuang impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT wenhsintseng impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT hsiangyinglee impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT hsinchihyeh impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT ihsuanalanchen impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT jentailin impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT pichechen impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT iansengcheong impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT thomasyhsueh impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT yuanhongjiang impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT yukhunlee impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT weichiehchen impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT shihhsiulo impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT pohunglin impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT shianshiangwang impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT chaoyuanhuang impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT chiachangwu impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT jenshutseng impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT shuyuwu impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy AT yaochoutsai impactofpathologicalresponseononcologicaloutcomesinpatientswithuppertracturothelialcancerreceivingneoadjuvantchemotherapy |