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Introduction: Limited and conflicting data are available regarding adjuvant and neoadjuvant chemotherapy in patients with locally advanced upper tract urothelial carcinoma (UTUC)of the renal pelvis. Here we present our experience with treatment of patients with T3 UC of the renal pelvis.
Methods: Patients diagnosed with UTUC at the Massachusetts General Hospital between January 1993 and March 2011 were reviewed. Forty-one patients with T3 disease of the renal pelvis on pathology were included. Ten patients received neoadjuvant (3) or adjuvant (7) chemotherapy. The mean follow-up was 41 months.
Results: The mean age 69 years old and 56% of the patients were female. There was no significant difference between the chemotherapy and control groups in age (66.2 vs 69.7 years, p=0.3), gender (60% vs 55% Female, p=0.8), high grade (84% vs 80%, p=0.8), lymphovascular invasion (50% vs 69%, p=0.4), N+ status (33% vs 32%, p=0.9), and positive margins (10% vs 9.7%, p=0.9). No significant difference in survival was seen amongst patients with parenchymal versus peri-hilar fat invasion (p=0.3). A significant difference in five-year disease-specific survival was seen between the group who received perioperative chemotherapy (5-yr survival 70%) and the group who did not receive any chemotherapy (5-yr survival 36.5%). When adjusted for age in a multivariate analysis, the use of perioperative chemotherapy significantly improved survival (HR 3.9).
Conclusion: Adjuvant or neoadjuvant chemotherapy confers a survival benefit in patients with T3 UTUC of the renal pelvis. Further prospective studies are warranted to validate these Results.