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Korean J Urol Oncol > Volume 6(1); 2008 > Article
The Korean Journal of Urological Oncology 2008;6(1): 18-23.
근치적 수술 후 림프혈관 침범을 동반한 요로 이행세포암 환자에서 보조적 화학요법의 효과
박성진, 조강수, 서주완, 이영훈, 최영득, 홍성준
연세대학교 의과대학 비뇨기과학교실, 비뇨의과학연구소
Effect of Adjuvant Chemotherapy in Urinary Tract Transitional Cell Carcinoma with Lymphovascular Invasion Following Radical Surgery
Sung Jin Park , Kang Su Cho , Joo Wan Seo , Young Hoon Lee , Young Deuk Choi , Sung Joon Hong
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
Published online: April 30, 2008.
ABSTRACT
Purpose:
In patients with urinary transitional cell carcinoma(TCC) after radical surgery, lymphovascular invasion is associated with poor prognosis. However, the role of adjuvant chemotherapy is not yet clear in these cases. We investigated the effect of adjuvant chemotherapy in urinary TCC with lymphovascular invasion following radical surgery.
Materials and Methods:
Between 1986 and 2004, data on 96 patients who were diagnosed of TCC of bladder and upper urinary tract with lymphovascular invasion after radical surgery were retrospectively reviewed. Patients with metastatic disease and those who underwent neoadjuvant chemotherapy were excluded. Eighty-nine patients were enrolled in this study. Of them, 44 patients(49.4%) received adjuvant chemotherapy. Kaplan-Meier method, log-rank test and Cox proportional hazards model were performed to determine associations between clinicopathological features and survival.
Results:
Forty patients(44.9%) died of cancer and 5-year disease-specific survival rate was 41.9%. T stage had a significant influence on disease-specific survival(p=0.004). However, sex, age, tumor location, tumor grade, concomitant carcinoma in situ and nodal involvement were not associated with survival(p>0.05). Meanwhile, 5-year disease-specific survival rate was higher in adjuvant chemotherapy group(50.3%) than those in observation group(34.5%), in borderline significance(p=0.065). On multivariate analysis, T stage(p=0.004, hazard ratio=2.735) and adjuvant chemotherapy(p=0.044, hazard ratio=0.548) were prognostic predictors in this study.
Conclusions:
Adjuvant chemotherapy improves oncological outcomes in TCC patients with lymphovascular invasion after radical surgery. However, prospective trials will be needed to elucidate our findings.(Korean J Urol Oncol 2008;6:18-23)
Key Words: Transitional cell carcinoma; Urinary tract; Lymphatic metastasis; Adjuvant chemotherapy
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