Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy

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

doi:10.1016/j.jfma.2023.06.003

Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy

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 WuJen Shu Tseng, Shu Yu Wu, Yao Chou Tsai

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2 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	1274-1281
Number of pages	8
Journal	Journal of the Formosan Medical Association
Volume	122
Issue number	12
DOIs	https://doi.org/10.1016/j.jfma.2023.06.003
State	Published - Dec 2023
Externally published	Yes

Keywords

Chemotherapy
Neo-adjuvant
Oncological outcomes
Upper tract urothelial cancer

ASJC Scopus subject areas

General Medicine

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10.1016/j.jfma.2023.06.003

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Yu, C. C., Chang, C. H., Fang, J. K., Huang, S. K., Tseng, W. H., Lee, H. Y., Yeh, H. C., Chen, I. H. A., Lin, J. T., Chen, P. C., Cheong, I. S., Hsueh, T. Y., Jiang, Y. H., Lee, Y. K., Chen, W. C., Lo, S. H., Lin, P. H., Wang, S. S., Huang, C. Y., ... Tsai, Y. C. (2023). Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy. Journal of the Formosan Medical Association, 122(12), 1274-1281. https://doi.org/10.1016/j.jfma.2023.06.003

Yu, CC, Chang, CH, Fang, JK, Huang, SK, Tseng, WH, Lee, HY, Yeh, HC, Chen, IHA, Lin, JT, Chen, PC, Cheong, IS, Hsueh, TY, Jiang, YH, Lee, YK, Chen, WC, Lo, SH, Lin, PH, Wang, SS, Huang, CY, Wu, CC, Tseng, JS, Wu, SY & Tsai, YC 2023, 'Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy', Journal of the Formosan Medical Association, vol. 122, no. 12, pp. 1274-1281. https://doi.org/10.1016/j.jfma.2023.06.003

@article{e3d2b5d39b7e46179770c523d00a2ac5,

title = "Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy",

abstract = "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.",

keywords = "Chemotherapy, Neo-adjuvant, Oncological outcomes, Upper tract urothelial cancer",

author = "Yu, {Chih Chin} and Chang, {Chao Hsiang} and Fang, {Jen Kai} and Huang, {Steven K.} and Tseng, {Wen Hsin} and Lee, {Hsiang Ying} and Yeh, {Hsin Chih} and Chen, {I. Hsuan Alan} and Lin, {Jen Tai} and Chen, {Pi Che} and Cheong, {Ian Seng} and Hsueh, {Thomas Y.} and Jiang, {Yuan Hong} and Lee, {Yu Khun} and Chen, {Wei Chieh} and Lo, {Shih Hsiu} and Lin, {Po Hung} and Wang, {Shian Shiang} and Huang, {Chao Yuan} and Wu, {Chia Chang} and Tseng, {Jen Shu} and Wu, {Shu Yu} and Tsai, {Yao Chou}",

note = "Publisher Copyright: {\textcopyright} 2023 Formosan Medical Association",

year = "2023",

month = dec,

doi = "10.1016/j.jfma.2023.06.003",

language = "English (US)",

volume = "122",

pages = "1274--1281",

journal = "Journal of the Formosan Medical Association",

issn = "0929-6646",

publisher = "Excerpta Medica Asia Ltd.",

number = "12",

}

TY - JOUR

T1 - Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy

AU - Yu, Chih Chin

AU - Chang, Chao Hsiang

AU - Fang, Jen Kai

AU - Huang, Steven K.

AU - Tseng, Wen Hsin

AU - Lee, Hsiang Ying

AU - Yeh, Hsin Chih

AU - Chen, I. Hsuan Alan

AU - Lin, Jen Tai

AU - Chen, Pi Che

AU - Cheong, Ian Seng

AU - Hsueh, Thomas Y.

AU - Jiang, Yuan Hong

AU - Lee, Yu Khun

AU - Chen, Wei Chieh

AU - Lo, Shih Hsiu

AU - Lin, Po Hung

AU - Wang, Shian Shiang

AU - Huang, Chao Yuan

AU - Wu, Chia Chang

AU - Tseng, Jen Shu

AU - Wu, Shu Yu

AU - Tsai, Yao Chou

PY - 2023/12

Y1 - 2023/12

N2 - 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.

AB - 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.

KW - Chemotherapy

KW - Neo-adjuvant

KW - Oncological outcomes

KW - Upper tract urothelial cancer

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U2 - 10.1016/j.jfma.2023.06.003

DO - 10.1016/j.jfma.2023.06.003

M3 - Article

C2 - 37400294

AN - SCOPUS:85164400939

SN - 0929-6646

VL - 122

SP - 1274

EP - 1281

JO - Journal of the Formosan Medical Association

JF - Journal of the Formosan Medical Association

IS - 12

ER -

Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy

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