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  • Title: The comparison of oncologic outcomes between metastatic upper tract urothelial carcinoma and urothelial carcinoma of the bladder after cisplatin-based chemotherapy.
    Author: Hsieh MC, Chiang PH, Rau KM, Chen YY, Su YL, Huang CH.
    Journal: Urol Oncol; 2015 Nov; 33(11):495.e9-495.e14. PubMed ID: 26254698.
    Abstract:
    OBJECTIVE: To compare the oncologic outcomes and prognostic factors between metastatic upper tract urothelial carcinoma (UTUC) and UC of the bladder (UCB) after cisplatin-based chemotherapy. MATERIALS AND METHODS: We retrospectively reviewed patients with metastatic UTUC and UCB after methotrexate/vinblastine/doxorubicin/cisplatin (MVAC) or gemcitabine/cisplatin chemotherapy between 1997 and 2014 at Kaohsiung Chang Gung Memorial Hospital. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan-Meier method. Univariate and multivariate analyses with Cox proportional hazard models were also performed to assess the effect of prognostic factors. RESULTS: Totally, 203 patients were enrolled into our study, including 120 patients with UTUC and 83 patients with UCB. For patients with UTUC, the median PFS was 7.3 months vs. 4.0 months (P<0.001), and the median OS was 17.0 months vs. 10.5 months (P<0.001) for MVAC and gemcitabine/cisplatin, respectively. For patients with UCB, the median PFS (P = 0.35) and OS (P = 0.06) of the 2 groups were insignificant. In multivariate analyses, number of metastatic sites was the identical prognostic factor for OS between UTUC (hazard ratio [HR] = 2.74; 95% CI: 1.63-4.62; P<0.001) and UCB (HR = 3.12; 95% CI: 1.52-6.39; P = 0.002). Presence of liver metastasis (HR = 1.84; 95% CI: 1.05-2.23; P = 0.03) and MVAC chemotherapy (HR = 0.54; 95% CI: 0.35-0.83; P<0.001) were significantly correlated to survival only for UTUC, not for UCB. CONCLUSION: Our study suggests discordant oncologic outcomes and prognostic factors between metastatic UTUC and UCB after cisplatin-based chemotherapy. A prospective study is warranted to validate our results.
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