Evidence map›Paper›PMID 32430254›Full record

ArticleUrologic oncology2020

Pathologic stage as a surrogate for oncologic outcomes after receipt of neoadjuvant chemotherapy for high-grade upper tract urothelial carcinoma.

Nirmish Singla, Alana Christie, Yuval Freifeld, Rashed A Ghandour, Solomon L Woldu, Timothy N Clinton, Firas G Petros, Haley Robyak, Hsin-Chih Yeh, Dong Fang and 7 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Urologic oncology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Trial
  2. Article
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Nirmish SinglaDepartment of Urology, The University of Texas Southwestern Medical Center, Dallas, TX.
Alana ChristieDivision of Biostatistics, Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, TX.
Yuval FreifeldDepartment of Urology, The University of Texas Southwestern Medical Center, Dallas, TX.
Rashed A GhandourDepartment of Urology, The University of Texas Southwestern Medical Center, Dallas, TX.
Solomon L WolduDepartment of Urology, The University of Texas Southwestern Medical Center, Dallas, TX.
Timothy N ClintonDepartment of Urology, The University of Texas Southwestern Medical Center, Dallas, TX.
Firas G PetrosDepartment of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Haley RobyakDivision of Urology, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA.
Hsin-Chih YehDepartment of Urology, The University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Dong FangDepartment of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
Dmitry EnikeevInstitute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
Aditya BagrodiaDepartment of Urology, The University of Texas Southwestern Medical Center, Dallas, TX.
Arthur I SagalowskyDepartment of Urology, The University of Texas Southwestern Medical Center, Dallas, TX.
Yair LotanDepartment of Urology, The University of Texas Southwestern Medical Center, Dallas, TX.
Jay D RamanDivision of Urology, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA.
Surena F MatinDepartment of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Vitaly MargulisDepartment of Urology, The University of Texas Southwestern Medical Center, Dallas, TX; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia. Electronic address: vitaly.margulis@utsouthwestern.edu.

Funding

NCI NIH HHS L30 CA129564
6 · The paper itself

Abstract

objectiveWhether pathologic stage at radical nephroureterectomy (RNU) can serve as an appropriate surrogate for oncologic outcomes in patients with high-grade (HG) upper tract urothelial carcinoma (UTUC) treated with neoadjuvant chemotherapy (NAC) is not defined. We sought to determine whether patients who achieve pathologically non-muscle-invasive (ypT0, ypTa, ypT1, ypTis) HG UTUC after receipt of NAC exhibit oncologic outcomes comparable to those who are inherently low stage without chemotherapy.

methodsWe identified 647 UTUC patients who underwent RNU among 3 institutions from 1993to2016. Patients with low or unknown grade, pathologic muscle invasion, or receipt of adjuvant chemotherapy were excluded. We compared clinicopathologic data and oncologic outcomes between pT0-1 and ypT0-1 patients. Kaplan-Meier analysis was used to assess overall (OS), cancer-specific (CSS), and systemic recurrence-free (RFS) survival. Predictors of these endpoints were identified using Cox regression.

results234 (43 ypT0-1, 191 pT0-1) patients with HG UTUC were included. Two patients exhibited pathologic complete response after NAC. OS (P = 0.055), CSS (P = 0.152), and RFS (P = 0.098) were similar between ypT0-1 and pT0-1 patients. Predictors of worse outcomes included African-American race (RFS, CSS, and OS), Charlson score (OS), and systemic recurrence (OS and CSS).

conclusionsPatients with HG UTUC who achieve ypT0-1 stage after NAC exhibit favorable oncologic outcomes comparable to those inherently non-muscle-invasive who do not receive chemotherapy. Improvements in clinical staging will play an important role in better defining candidacy for NAC in treating HG UTUC while minimizing overtreatment. Furthermore, pathologic stage may serve as an appropriate early surrogate for oncologic endpoints in designing clinical trials.

Indexed as

AgedCarcinoma, Transitional CellChemotherapy, AdjuvantCohort StudiesFemaleHumansKidney NeoplasmsMaleMiddle AgedNeoadjuvant TherapyNeoplasm GradingNeoplasm StagingTreatment OutcomeUreteral NeoplasmsNeoadjuvant chemotherapyPathologic responseRadical nephroureterectomyUpper tract urothelial carcinoma

Identifiers

PMID32430254
PMCPMC10676742

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.