Introduction

We reported that tumor invades peripelvic fat or periureteral fat (pT3b) had worse prognosis than tumor invades renal parenchyma (pT3a)¹. We evaluated the disease recurrence and cancer specific survival of patients with pT3b urothelial carcinoma of the upper urinary tract who received adjuvant treatment._x000D_ _x000D_ Reference_x000D_ 1. Park, J., et al., Peripelvic/periureteral fat invasion is independently associated with worse prognosis in pT3 upper tract urothelial carcinoma. World J Urol, 2014. 32(1): p. 157-63._x000D_

Methods

The data from a total of the 128 pT3b patients after radical nephroureterectomy were analyzed. The patients were divided into 4groups; 60 without adjuvant therapy (Group 1), 22 with adjuvant radiotherapy (Group 2), 27 with adjuvant chemotherapy (Group 3) and 19 with adjuvant radiotherapy plus adjuvant chemotherapy (Group 4). Recurrence-free survival and cancer specific survival rates were compared among these groups.

Results

The median follow-up duration was 43.7 months. The patients who received adjuvant radiotherapy (Group 2 and 4) were more likely to have high pathologic grade (p=0.036) and more frequent positive surgical margin (p=0.010), but were no differences by gender, age, tumor location, status of lymphovascular invasion. 5-year recurrence-free survival rates of group 1, group 2, group 3 and group 4 were 31.3%, 66.3%, 26.1% and 57.9%, respectively. The patients who received adjuvant radiotherapy (Group 2 and 4) showed significantly higher recurrence free survival than those who did not. Low recurrence rates after adjuvant radiotherapy may be due to decreased local recurrence (HR 0.129, p=0.005). 5-year cancer specific survival rates in group 1, group 2, group 3 and group 4 were 51.6%, 50.6%, 50.6% and 72.7%, respectively. Higher cancer specific survival was noted in group 4, but didn&[prime]t reach statistical significance (p=0.119).

Conclusions

The Adjuvant radiotherapy in pT3b patients significantly reduced disease recurrence. Adjuvant radiotherapy plus chemotherapy seem to increase the cancer specific survival. The adjuvant radiotherapy plus chemotherapy should be considered in patients with pT3bN0/Nx.

Funding

none