Journal
EUROPEAN UROLOGY
Volume 71, Issue 5, Pages 714-718Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.eururo.2016.11.012
Keywords
Urothelial carcinoma; Ureteral neoplasms; Ureter; Renal pelvis; Drug therapy; Propensity score; Survival
Categories
Funding
- Pierre Fabre
- Astellas Pharma
- Pfizer
- Merck
- Genentech
- Novartis
- Millennium Pharmaceuticals
- Sanofi
- Sanofi Pasteur
- IPSEN
- Takeda Pharmaceuticals
- Bayer AG
- GlaxoSmithKline
- Bristol-Myers Squibb
- Eisai
- Prometheus Labs
- Foundation Medicine Research
- Cerulean Pharma
- AstraZeneca
- Peloton
- Exelixis
- TRACON Pharmaceuticals
- Peloton Therapeutics
- GenomeDx Biosciences
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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 chemotherapy alone, respectively. Inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier curves showed that 3-yr OS was 16.2% (95% confidence interval [CI] 12.120.3) 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 chemotherapy alone in fit patients. (C) 2016 European Association of Urology. Published by Elsevier B. V. All rights reserved.
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