Impact of adjuvant chemotherapy on oncologic outcomes following radical nephroureterectomy for patients with pT3NanyM0 upper tract urothelial carcinoma: A retrospective cohort study

Objective: We investigated the impact of cisplatin-based adjuvant chemotherapy (AC) on oncologic outcomes including recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) after radical nephroureterectomy (RNU) for patients with pT3NanyM0 upper tract urothelial carcinoma (UTUC). Methods: We retrospectively reviewed 293 patients who underwent RNU for UTUC between 1995 and 2017. Clinicopathologic characteristics of patients were examined and compared according to the use of AC. Kaplan-Meier survival analysis was used to illustrate RFS, CSS and OS. Cox proportional hazard models were applied to identify factors predicting oncologic outcomes. Results: Among the 293 total patients, 127 (43.3%) patients received AC. During a mean follow-up of 59.7 months, recurrence and/or distant metastasis were identified in 124 (42.3%) patients, and 106 (36.2%) patients died overall, of which 93 (31.7%) died from UTUC. The 5-year RFS, CSS and OS rates of overall patients were 51.3%, 68.0% and 64.7%, respectively. In multivariate analysis, AC was inversely associated with tumor recurrence (HR = 0.74, P = 0.028) but not significantly associated with death from UTUC (P = 0.237) and death from all-cause (P = 0.433). The 5-year RFS of patients who had received AC was 58.0%, while 44.0% for patients who had only been observed after RNU. Conclusion: AC improved RFS, but did not have a significant effect on CSS and OS in patients with pT3NanyM0 UTUCs following RNU. Further efforts are needed to identify reliable criteria in the clinic for patients that would benefit from AC.