Login to Access Video or Poster Abstract: MP71-13
Sources of Funding: none

Introduction

Our recent findings from a multi-institutional study showed that up to one-third of upper tract urothelial carcinoma (UTUC) patients did not receive any chemotherapeutic treatment (CTx) for disease recurrence after radical nephroureterectomy (RNU) due to their high age, poor performance status (PS), and comorbidity. However, some patients may not have the chance to receive effective systemic CTx simply because of their advanced age. In this study, we attempted to determine the influence of age on the outcomes of CTx in UTUC patients with disease recurrence following RNU.

Methods

We identified a study population of 226 patients who developed disease recurrence after RNU during the past 15 years at our 14 Japanese institutions. To identify factors that were related to cancer-specific survival (CSS) and overall survival (OS), we performed multivariate analysis using a Cox proportional hazards regression model that included clinicopathological variables. We also analyzed the efficacy of systemic CTx in a subgroup of patients aged >75 years (yr).

Results

After disease recurrence, 145 patients underwent systemic CTx while the remaining 81 received no systemic treatment. Patients aged >75 yr (n=81) tended to have poor PS (P<0.001) and bone metastasis at the time of disease relapse (P=0.028) compared with the younger patients (n=145), while the administration of adjuvant CTx was less frequent (14.8% in patients aged >75 yr vs. 42.1% in those <75 yr, P<0.001). Multivariate analysis in the overall population revealed that the salvage CTx setting was independently related to CSS as well as OS along with poor PS, the presence of liver metastasis, number of recurrence sites, and lymph node involvement in RNU specimens. Meanwhile, age was not selected as an independent factor. In the subgroup analysis on patients >75 yr, we found no significant difference in the clinicopathological backgrounds among patients who received systemic CTx (n=38) and their counterparts (n=43). However, CSS rates in patients with systemic CTx were 41.8% at 1 year and 18.6% at 2 years, while those without were significantly decreased to 10.2% and 6.8% (P=0.001), respectively. A similar difference could be observed in the estimated probability of OS among patients aged >75 yr. _x000D_ _x000D_

Conclusions

Survival rates are significantly higher in patients receiving salvage systemic CTx regardless of their age. Age is not a key indicator for selecting candidates for systemic CTx with disease recurrence after RNU.

Funding

none