Adjuvant chemotherapy after radical nephroureterectomy improves the survival outcome of high-risk upper tract urothelial carcinoma patients with cardiovascular comorbidity

• Published in: Scientific reports 2020-10, Vol.10 (1), p.17674-17674, Article 17674
• Main Authors: Luo, Yong, Feng, Bingfu, Wei, Dechao, Han, Yili, Li, Mingchuan, Zhao, Jiahui, Lin, Yunhua, Hou, Zhu, Jiang, Yongguang
• Format: Article
• Language: English
• Subjects: 631/67/1059/99; 692/4025/2768/589; Adult; Aged; Aged, 80 and over; Cardiovascular Diseases - complications; Cardiovascular Diseases - mortality; Chemotherapy, Adjuvant; Female; Humanities and Social Sciences; Humans; Kaplan-Meier Estimate; Kidney Neoplasms - complications; Kidney Neoplasms - drug therapy; Kidney Neoplasms - mortality; Kidney Neoplasms - surgery; Male; Middle Aged; multidisciplinary; Nephroureterectomy; Proportional Hazards Models; Science; Science (multidisciplinary); Survival Analysis; Ureteral Neoplasms - complications; Ureteral Neoplasms - drug therapy; Ureteral Neoplasms - mortality; Ureteral Neoplasms - surgery
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-74940-x

This prospective randomized comparative trial study aimed to evaluate the therapeutic outcomes of radical nephroureterectomy and adjuvant chemotherapy (ACT) used in combination in high risk upper tract urothelial carcinoma (UTUC) patients with cardiovascular comorbidity. Based on the inclusion criteria of high-risk UTUC in EAU guidelines (updated in 2014), all eligible patients treated in our hospital from January 2014 to March 2018 were included, and cases with late disease, renal dysfunction, severe cardiopulmonary disease or other malignant tumors were excluded. The cases were randomized into two groups based on treatment regimen. Multivariate analyses were performed to analyze the influencing factors of survival outcome in the enrolled patients. The Cox proportional-hazards model and the Kaplan–Meier method were employed to assess progression free survival (PFS), overall survival (OS) and cancer specific survival (CSS). In addition, the potential adverse effects of chemotherapy were actively monitored. A total of 176 high-risk UTUC individuals with cardiovascular comorbidity were enrolled and evaluated in this study. Median follow-up durations were 30 months (range 6–54) in the RNU (n = 82) group and 36 months (range 6–54) in the RNU + ACT (n = 94) group. Multivariable analysis indicated that peri-operative cardiovascular events risk grade was independent prognostic factor for OS. Tumor size was independent prognostic factor for PFS and CSS. BMI and lymphovacular invasion were significant predictors of PFS. Clinical stage, lymph node involvement, and tumor grade were significant predictors of PFS, OS and CSS in these patients. Especially, chemotherapy was helpful in improving PFS [ P