目的:本研究的目的是评估接受新辅助化疗的上尿路上皮癌患者的病理完全缓解率(ypT0N0/X)和病理缓解率(ypT1N0/X或更低),并研究其对肿瘤预后的影响。
方法:本研究是对2002年至2021年间接受新辅助化疗和根治性肾输尿管切除术的高风险上尿路尿路上皮癌患者的多机构回顾性分析。使用Logistic回归分析来研究新辅助化疗后反应的所有临床参数。进行Cox比例风险模型以评估反应对肿瘤学结果的影响。
结果:共84例接受新辅助化疗的UTUC患者。其中,44例(52.4%)患者接受以顺铂为基础的化疗,22例(26.2%)患者采用以卡铂为基础的方案.病理完全缓解率为11.6%(n=10),病理反应率为42.9%(n=36)。多灶性肿瘤或大于3厘米的肿瘤显着降低了病理反应的几率。在多变量Cox比例风险模型中,病理反应与更好的总生存期独立相关(HR0.38,p=0.024),癌症特异性生存率(HR0.24,p=0.033),和无复发生存率(HR0.17,p=0.001),但与无膀胱复发生存率无关(HR0.84,p=0.69).
结论:新辅助化疗和根治性肾输尿管切除术后的病理反应与患者的生存和复发密切相关。它可能是未来评估新辅助化疗疗效的一个很好的替代方法。
OBJECTIVE: 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).
CONCLUSIONS: 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.