1. Upper Tract Urothelial Carcinomas: Prognostic Factors and Outcomes in Patients With Non–Lymph Node Distant Metastasis
- Author
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Matthew S. Farina, Kevin Lundgren, Elena Sevillano, Guillermo Velasco, Dominick Bossé, Aly-Khan A. Lalani, Joaquim Bellmunt, Lillian Werner, Stephanie A. Wankowicz, Aranzazu Gonzalez del Alba, and Toni K. Choueiri
- Subjects
Male ,Oncology ,Urologic Neoplasms ,medicine.medical_specialty ,Anemia ,Urology ,030232 urology & nephrology ,Antineoplastic Agents ,Nephroureterectomy ,Hemoglobins ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Internal medicine ,medicine ,Humans ,Neoplasm Metastasis ,Lymph node ,Survival analysis ,Aged ,Carcinoma, Transitional Cell ,Framingham Risk Score ,Performance status ,Proportional hazards model ,business.industry ,Cancer ,Middle Aged ,Prognosis ,medicine.disease ,Survival Analysis ,Clinical trial ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Cisplatin ,business - Abstract
Background Upper tract urothelial carcinomas (UTUCs) are increasingly recognized as separate malignancies. Additional insight into clinical outcomes and key prognostic factors are needed. Objectives To detail outcomes of patients with UTUCs recurring after radical nephroureterectomy (RNU) and to determine a risk score that predicts outcomes of patients with non–lymph node distant metastasis. Design, Setting, and Participants Chart review of all patients who had an extraurothelial recurrence after RNU for UTUC at Dana-Farber Cancer Institute between 2009 and 2014. Outcome Measurements and Statistical Analysis Median overall survival defined as time from chemotherapy for distant relapse to death. Prognostic relevance of performance status, hemoglobin, and receipt of cisplatin were assessed by Cox regression model. Results and Limitations A total of 102 patients were identified, 57 of whom had non–lymph node distant metastases at relapse; 45 received chemotherapy. Median follow-up was 29.8 months; median overall survival was 14.7 months. Objective response rate to any chemotherapy in the first-line setting was only 22%. Hemoglobin > 11 g/dL and receipt of cisplatin was associated with numerically longer median survival but did not reach statistical significance in univariate and multivariate analysis. Prognostic risk score scale including hemoglobin Conclusions Advanced UTUC portends a poor prognosis, and most patients cannot receive cisplatin-based chemotherapy. A risk score that includes anemia and receipt of cisplatin helps stratify patients with distant metastasis for inclusion into eventual clinical trials. More studies are needed to validate these findings. Patient Summary Metastatic UTUC is an aggressive disease, where anemia and ineligibility to receive cisplatin are adverse features associated with shorter survival.
- Published
- 2017