Pathological downstaging as a novel endpoint for the development of neoadjuvant chemotherapy for upper tract urothelial carcinoma.

BJU International
Alberto MartiniJohn P Sfakianos

Abstract

To evaluate whether pathological downstaging (pDS) was more informative in predicting overall survival (OS) than pathological complete response (pCR) in patients treated with neoadjuvant chemotherapy (NAC) for upper tract urothelial carcinoma (UTUC). The National Cancer Database was queried for patients with high-grade cN0M0 disease who had received NAC. pDS was defined as a decrease of at least one stage from cT to pT stage along with pN0, including pCR. A multivariable Cox model predicting OS was generated by fitting alternatively either pDS or pCR, and adjusted for potential confounders. The discrimination of the Cox models for predicting OS was evaluated using Harrell's C-index. The analyses were repeated in patients diagnosed as having cT2-4N0M0 disease. Among 264 patients meeting the inclusion criteria, 72 (27%) and 39 (15%) achieved pDS and pCR, respectively. On multivariable analysis, both pDS (hazard ratio [HR] 0.24, 95% confidence interval [CI] 0.13, 0.45; P < 0.001) and pCR (HR 0.37, 95% CI 0.18, 0.79; P = 0.01) were associated with OS. The model including pDS achieved better discrimination with respect to the model including pCR: C-index 76.4 vs 72.7, respectively. In the 128 patients diagnosed with cT2-4 disease, b...Continue Reading

References

Mar 9, 2005·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·James W F CattoFreddie C Hamdy
Jan 22, 2009·Cancer·Vitaly MargulisUNKNOWN Upper Tract Urothelial Carcinoma CollaborationThe Upper Tract Urothelial Carcinoma Collaboration
Oct 2, 2012·The Journal of Urology·David A GreenShahrokh F Shariat
Mar 29, 2014·Annals of Oncology : Official Journal of the European Society for Medical Oncology·H KitamuraUNKNOWN Urologic Oncology Study Group of the Japan Clinical Oncology Group
Aug 19, 2015·European Urology·John P SfakianosJonathan A Coleman
Jan 10, 2017·Urologic Oncology·Andrew CohenSangtae Park
Jul 1, 2018·Critical Reviews in Oncology/hematology·Richard W GreggTimothy P Hanna

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