Adjuvant Chemotherapy Little Help for Urothelial Cancer

Few patients offered this option after surgery; minimal impact on odds of survival

FRIDAY, Aug. 21 (HealthDay News) -- Patients treated surgically for upper tract urothelial carcinoma are not usually offered adjuvant chemotherapy, and for those who are, the treatment does not seem to have much impact on the odds of survival, according to a study published in the September issue of the Journal of Urology.

Nicholas J. Hellenthal, M.D., of the University of California-Davis Medical Center in Sacramento, and colleagues conducted a study of 1,390 patients with non-metastatic upper tract urothelial carcinoma, of which 542 (39 percent) were considered high risk. The high-risk patients were then classified based on whether or not they received adjuvant chemotherapy.

In all, 121 (22 percent) of the high-risk patients underwent adjuvant chemotherapy, and those with increased tumor grade and stage were more likely to be in this cohort, the researchers found. Whether or not they received adjuvant chemotherapy, overall and cancer-specific survival rates were similar, whereas age, tumor grade and performance status all had an impact on the odds of survival, the investigators report.

"Median survival in patients diagnosed with high-risk upper tract urothelial carcinoma after nephroureterectomy was in the order of two years regardless of the receipt of adjuvant chemotherapy," the authors write. "As in bladder urothelial cancer, there may be benefit to neo-adjuvant chemotherapy. However, to our knowledge an accurate and reproducible means of preoperative risk assessment for upper tract urothelial carcinoma remains to be identified."

One of the study authors reported financial interests in or other relationships with Antigenics, Pfizer, Bayer/Onyx, the Kidney Cancer Association, and Ethicon.

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