Fujita K, et al. - This propensity score-matched analysis was conducted to investigate if adjuvant chemotherapy (AC) improved the prognosis of patients with high-risk upper urinary tract urothelial carcinoma (UTUC) and to identify the patients who benefited from AC. AC after radical nephroureterectomy (RNU) benefitted high-risk UTUC patients. This beneficial impact was particularly evident among subgroups of patients with lower sodium and hemoglobin levels.

Methods

• Researchers identified 1,014 patients who underwent RNU for UTUC in a multi-center database.
• Of these, 344 patients with ≥ pT3 or the presence of lymphovascular invasion (LVI) were included.
• By the Kaplan-Meier method, cancer-specific survival (CSS) was estimated, and groups were compared by the log-rank test.
• Logistic regression models were used to assess each patient’s probability of receiving AC depending on the covariates in each group.
• To adjust the confounding factors for selecting patients for AC, propensity score matching was used, and to these propensity score-matched cohorts, log-rank tests were applied.
• They used Cox proportional hazards regression modeling to assess the variables with significant interaction with AC.
• The included variables were age, pT category, LVI, tumor grade, ECOG performance status and low sodium or hemoglobin score, which they reported to be a prognostic factor of UTUC.

Results

• In this study, 241 (70%) of the 344 patients received RNU only and 103 (30%) received RNU+AC.
• The median follow-up period of 32 (range 1–184) months was noticed.
• No improvement in CSS with AC was observed (P=0.12).
• After propensity score matching, patients with RNU+AC indicated the 5-year CSS of 69.0% compared to 58.9% in patients with RNU alone (P=0.030).
• They performed subgroup analyses of survival to assess the patients who benefitted from AC.
• Benefits from AC were observed among subgroups of patients with low preoperative serum sodium (≤ 140 mEq/ml) or hemoglobin levels below the normal limit (HR 0.34, 95% CI 0.15–0.61, P=0.001).
• In the subgroup of patients with normal sodium and normal hemoglobin levels, patients with RNU+AC indicated 5-year CSS of 77.7% versus 80.2% in patients with RNU alone (P=0.84).
• Contrary to this, in the subgroup of patients with low sodium or low hemoglobin levels, patients with RNU+AC indicated 5-year CSS of 71.0% in comparison to 38.5% in patients with RNU alone (P < 0.001).