Postoperative Adjuvant Systemic Chemotherapy for Locally Advanced Transitional Cell Carcinoma of the Upper Urinary Tract

Jeong, In Gab; Kwak, Cheol; Jeong, Hyeon; Lee, Hyun Moo; Lee, Eun sik; Lee, Chong wook; Lee, Sang Eun

Abstract

PURPOSE: The outcome of adjuvant systemic chemotherapy, in patients with a locally advanced transitional cell carcinoma of the upper urinary tract, was analyzed.
MATERIALS AND METHODS
Between January 1990 and June 2001, a total of 97 patients underwent surgery for a transitional cell carcinoma of the upper urinary tract at our institute. Forty-five had a locally advanced disease (T3, N1, N2, lymphovascular invasion). Of these, 33 patients (chemotherapy group) underwent a median of four courses of cisplatin-based adjuvant systemic chemotherapy (M-VAC in 23, gemcitabine plus cisplatin in seven, CISCA in three), whereas 12 (Observation group) refused chemotherapy. To define possible prognostic factors in these patients, various factors, including age, sex, location, surgical method, pT stage and number of involved lymph nodes, were analyzed using the Cox's regression model.
RESULTS
The mean follow-up was 39 months, ranging from 8 to 98 months; the median survival time in the chemotherapy and observation groups were 65 and 31 months, respectively. Five-year disease-specific survival rates in the chemotherapy and control groups were 71.1 and 40.9%, respectively. Of the several factors, adjuvant chemotherapy (p=0.016) and lymph node metastasis (p=0.017) both had prognostic significance. In the chemotherapy group, 21 (63.6%) were given a reduced dose for at least one cycle due to a reduced renal function. However, there was no fatal febrile neutropenia, while cellulitis or grade 3 neutropenia occurred in six patients during the chemotherapy.
CONCLUSIONS
Our findings suggest that adjuvant systemic chemotherapy, for a locally advanced transitional cell carcinoma of the upper urinary tract, may lead to a significant prolongation in the survival time.