ADJUVANT GEMCITABINE-CISPLATIN CHEMOTHERAPY OF INVASIVE TRANSITIONAL CELL CARCINOMA OF THE UPPER URINARY TRACT

초록

Introduction & Objectives: To evaluate the therapeutic benefit of adjuvant gemcitabine-cisplatin combination chemotherapy(GC) after nephroureterectomy with bladder cuff resection in patients with invasive transitional cell carcinoma(TCC) of the upper urinary tract. Material & Methods: From June 1998 to December 2005, 51 patients (40 men, 11 women) had invasive(Stage pT2 or pT3) TCC, not metastatic and nephroureterectomy with bladder cuff resection were performed. Of these 51 patients, 25 patients were scheduled to receive more than three courses of GC chemotherapy. The median follow-up period of all the evaluated patients was 17.8 months(range 0.77 to 40.6). Results: 28 out of 51 patients (54.9%) subsequently developed recurrence with a latent period of 4 to 20 months(median 10.3 months). Recurrence of 28% in patients who underwent chemotherapy, and recurrence of 76.9% who did not, were observed, respectively (P=0.000). Disease-free and overall survival were greater in the adjuvant GC chemotherapy group than in the non-adjuvant chemotherapy group(P=0.105, P=0.001, respectively, log-rank test for trend). Univariate Cox proportional hazard model analysis revealed that lymph node involvement(P=0.027), performance status(P=0.025), adjuvant GC chemotherapy(P=0.001) were associated with overall survival. Multivariate Cox proportional hazard model analysis revealed that performance status(P=0.000), adjuvant GC chemotherapy(P=0.001) was associated with overall survival. In the adjuvant GC chemotherapy group, Grade 3 or grade 4 toxicities included anemia(8%), granulocytopenia(20%), thrombocytopenia(20%), fever(4.0%) respectively. Nonhematological toxicities were mild. Conclusions: Our results indicated that adjuvant GC chemotherapy can provide therapeutic benefit in the treatment of patients with invasive transitional cell carcinoma of the upper urinary tract.