Impact of Adjuvant Systemic Chemotherapy on Invasive Urothelial Cell Carcinoma of the Upper Urinary Tract

Background: The objective of this stud y was to retrospectively investigate the effectiveness of adjuvant methotrexate, epirubicin, and cisplatin (MEC) combination chemotherapy for invasive urothelial cell carcinoma (VCC) of the upper urinary tract. Materials and Methods: Between 1988 and 1996, 65 patients diagnosed with invasive VCC of the upper urinary tract underwent radical operation at one institution. Among them, 58 patients identified from medical records were enrolled in this study. Fifteen patients had lymph node-positive disease and 43 patients did not. Thirty-six patients received MEC chemotherapy and 22 patients were observed after surgery. Cox proportional hazards models were used to determine the impacts of clinicopathological findings on survival. A subgroup analysis of patients with lymph node-positive disease was conducted to evaluate disease-free survival and overall survival rates. Results: The median interval between operation and chemotherapy was 5.6 weeks (range, 3-13) and the median follow-up period was 36 months (range, 2-105) after surgery. Disease-free and overall survival rates were 59% and 64%, respectively, at 3 years. Only lymph node status was significantly associated with disease-free and overall survival on multivariate analysis. On subgroup analysis of patients with lymph node-positive disease, 9 patients who underwent adjuvant chemotherapy had superior disease-free survival compared to 6 patients who did not undergo adjuvant chemotherapy (p=0.0434). Conclusion: These findings showed that the prognosis of invasive VCC of the upper urinary tract is significantly associated with nodal status. Adjuvant MEC chemotherapy is feasible and has a positive impact on survival of patients with lymph node-positive disease. Based on these findings, we can select patients with nodal involvement for adjuvant chemotherapy, which may extend the median survival and reduce the rate of cancer death.