التفاصيل البيبلوغرافية
| العنوان: |
Neoadjuvant Versus Adjuvant Chemotherapy for Upper Tract Urothelial Carcinoma: A Microsimulation Model. |
| المؤلفون: |
Hird, Amanda E., Magee, Diana E., Cheung, Douglas C., Sander, Beate, Sridhar, Srikala, Nam, Robert K., Kulkarni, Girish S. |
| المصدر: |
Clinical Genitourinary Cancer; Apr2021, Vol. 19 Issue 2, pe135-e147, 13p |
| مصطلحات موضوعية: |
TRANSITIONAL cell carcinoma, CANCER chemotherapy, ONCOLOGIC surgery, MICROSIMULATION modeling (Statistics), CLINICAL trials |
| مستخلص: |
There are no definitive recommendations regarding the timing of perioperative chemotherapy in upper tract urothelial carcinoma (UTUC). In this decision model, we compared nephroureterectomy alone, neoadjuvant chemotherapy (NAC), and adjuvant chemotherapy (AC) in patients with clinically localized UTUC. NAC resulted in greater quality adjusted and crude life-years than AC and surgery alone. This study provides evidence to support the increased use of NAC until robust clinical trials are completed. Background: Upper tract urothelial carcinoma (UTUC) is clinically understudied, and there are no definitive recommendations regarding timing of perioperative chemotherapy. The objective of this study was to compare 3 treatment pathways in UTUC: nephroureterectomy (NU) alone, neoadjuvant chemotherapy (NAC), and adjuvant chemotherapy (AC) using a microsimulation model. Patients and Methods: An individual-level state transition model was constructed using TreeAgePro software to compare treatment strategies for patients with newly diagnosed UTUC. The base case was that of a 70-year-old patient with a radiographically localized upper tract tumor. Primary outcome was quality-adjusted life expectancy. Secondary outcomes included crude overall survival, rates of adverse events, and bladder cancer diagnoses. Results: A total of 100,000 patients were simulated. NAC was preferred, with an estimated quality-adjusted life expectancy of 7.50 years versus 6.79 years with NU alone and 7.23 years with AC. Median crude overall survival was 123 months with NAC, 96 months with NU only, and 111 months with AC. Overall, 40.0% of patients in the AC group with invasive pathology completed chemotherapy. In the NAC group, 83.3% of patients completed chemotherapy. In the NAC group, 37.5% of patients experienced an adverse chemotherapy event compared to 15.1% of patients in the AC group. Bladder cancer recurrence rates were 64.9%, 65.9%, and 67.4% over the patient's lifetime for the NU, NAC, and AC strategies, respectively. Conclusion: This study supports the increased use of NAC in UTUC until robust randomized trials are completed. The ultimate choice should be based on patient and tumor factors. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
