@Article{,
AUTHOR = {Facundo Davaro, Allison May, Coleman McFerrin, Syed J. Raza, Sameer Siddiqui, Zachary Hamilton},
TITLE = {Chemotherapy increases survival and downstaging of upper tract urothelial cancer},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {26},
YEAR = {2019},
NUMBER = {5},
PAGES = {9938--9944},
URL = {http://www.techscience.com/CJU/v26n5/60491},
ISSN = {1488-5581},
ABSTRACT = {<b>Introduction:</b> To evaluate the overall survival and pathologic downstaging effect of neoadjuvant chemotherapy for upper tract urothelial cell carcinoma.<br/>
<b>Materials and methods:</b> The National Cancer Database (NCDB) was queried for patients with stage II-IV upper tract urothelial cell carcinoma undergoing definitive surgical resection (nephroureterectomy) from 2004-2015. Patients with metastatic disease were excluded. Cohorts were stratified by receipt of neoadjuvant chemotherapy (NAC). Kaplan-Meier analysis and Cox regression were used to evaluate overall survival. Logistic regression was used to predict the odds of pathologic downstaging to non-invasive disease (< pT2). Propensity score matched analysis was performed between groups.<br/>
<b>Results:</b> A total of 3634 patients were identified with non-metastatic stage II-IV disease undergoing surgical resection; 3364 received no chemotherapy and 270 received NAC. Patients undergoing NAC had a 10.9% rate of downstaging to non-invasive disease (OR 6.35, p < 0.001). Moreover, on Kaplan-Meier analysis, median survival was 27.3 months and 44.8 months for no chemotherapy versus NAC, respectively (log-rank, p = 0.001). Cox regression for death also revealed benefits for receiving NAC (HR 0.67, p < 0.001). Findings were confirmed on propensity score matching (532 matched patients). After matching, Cox regression for death noted improvement with neoadjuvant as compared to no chemotherapy (HR 0.61, p < 0.001).<br/>
<b>Conclusion:</b> Neoadjuvant chemotherapy increases likelihood of downstaging to non-invasive disease in patients with upper tract urothelial cell carcinoma. Chemotherapy also provides an overall survival benefit in patients undergoing nephroureterectomy.},
DOI = {}
}