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Abstract
PURPOSE:
We assessed the efficacy of adjuvant treatments in patients with peripelvic/periureteral fat-infiltrating (pT3b), nonmetastatic upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy.

METHODS AND MATERIALS:
The multicenter data of 222 patients with pT3bN0-x disease treated with radical nephroureterectomy were analyzed. The effects of adjuvant radiation therapy and chemotherapy on local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS) were evaluated.

RESULTS:
Adjuvant radiation therapy and chemotherapy were given to 39 (17.6%) and 74 patients (33.3%), respectively. Seventeen patients (7.7%) received concomitant adjuvant radiation therapy and chemotherapy. The median follow-up duration was 34.4 months. After adjusting for age, sex, tumor location, multifocality, tumor grade, presence of lymphovascular invasion, surgical margin, execution of node dissection, and other types of concomitant adjuvant treatment (radiation therapy or chemotherapy) through propensity-scored matching, adjuvant radiation therapy significantly reduced the local recurrence (5-year LRFS, 83.9 vs 54.2%; P = .001), distant metastasis (5-year DMFS, 72.1 vs 48.1%; P = .032), and cancer-specific death (5-year CSS, 76.4% vs 55.5%; P = .038) in pT3b UTUC. However, in the same condition, adjuvant chemotherapy did not reduce the local recurrence (5-year LRFS, 69.0% vs 66.2%; P = .786), distant metastasis (5-year DMFS, 65.3% vs 61.1%; P = .436), and cancer-specific death (5-year CSS, 67.9% vs. 67.9%; P = .458) in pT3b UTUC.

CONCLUSIONS:
Our study suggests that adjuvant radiation therapy may be beneficial in patients with T3bN0-x UTUC; however, prospective clinical trials are needed to clarify this issue.

Author information

Kim M1, Kim JK2, Lee J2, Kim YS3, Lee JL4, Kwak C5, Jeong CW5, Byun SS1, Lee SC1, Ohyama C6, Arai Y7, Ahn H8.
1
Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Sungnam, Republic of Korea.
2
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
3
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
4
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
5
Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
6
Department of Urology, Hirosaki University Hospital, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
7
Department of Urology, Tohoku University Hospital, Tohoku University School of Medicine, Sendai, Japan.
8
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: hjahn@amc.seoul.kr.