Jincong Li, Yuxuan Song, Rui Chen, Hanlin Gao, Yang Liu, Yun Peng, Jilin Wu, Shicong Lai, Yiqing Du, Caipeng Qin, Tao Xu
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Cox model-adjusted survival curves and multivariable Cox regression were performed using SPSS and R software.</p><p><strong>Results: </strong>Compared with ACT, NACT alone did not significantly impact survival (hazard ratio [HR] 0.834, 95% confidence interval [CI] 0.392-1.774, p = 0.638), whereas ACT + NACT (HR 0.389, 95% CI 0.169-0.895, p = 0.026) and ICT + ACT + NACT (HR 0.466, 95% CI 0.246-0.883, p = 0.019) positively affected UC prognosis. However, when compared with the combination of ACT + NACT, the combination of ICT + ACT + NACT did not show a statistically significant effect (HR 1.198, 95% CI 0.427-3.362, p = 0.731). Compared with no chemotherapy, ACT reduced renal UC survival (HR 1.430, 95% CI 1.105-1.850, p = 0.007) but improved ureter (HR 0.460, 95% CI 0.232-0.915, p = 0.027) and bladder UC survival (HR 0.605, 95% CI 0.466-0.785, p < 0.001).</p><p><strong>Conclusions: </strong>Prognosis after chemotherapy varied depending on different tumor locations. ACT reduced the prognosis of renal UC patients but elevated the prognosis of ureter UC and bladder UC patients. Distinct chemotherapy protocols have also yielded varying prognostic outcomes. For UC patients, the combination of ACT + NACT merits consideration in order to achieve better prognostic outcomes than the use of ACT or NACT alone. The adoption of ICT for UC patients may not be necessary.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"6141-6150"},"PeriodicalIF":3.4000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Improving Urothelial Carcinoma Outcomes: The Powerful Combination of Neoadjuvant and Adjuvant Chemotherapy in the Perioperative Period.\",\"authors\":\"Jincong Li, Yuxuan Song, Rui Chen, Hanlin Gao, Yang Liu, Yun Peng, Jilin Wu, Shicong Lai, Yiqing Du, Caipeng Qin, Tao Xu\",\"doi\":\"10.1245/s10434-025-17154-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>To enhance urothelial carcinoma (UC) prognosis, clinicians combine surgery with intraoperative (ICT), neoadjuvant (NACT), or adjuvant chemotherapy (ACT); however, studies on their individual and combined effects vary. Furthermore, studies on the combined use of ACT and NACT are scarce.</p><p><strong>Objective: </strong>This study aimed to assess the impact of these chemotherapy regimens on UC prognosis, particularly the effectiveness of ACT + NACT, using the Surveillance, Epidemiology, and End Results (SEER) database.</p><p><strong>Methods: </strong>We analyzed 45,211 UC cases from 2019 to 2021, focusing on renal, ureter, bladder, prostate, and urethra UC. Cox model-adjusted survival curves and multivariable Cox regression were performed using SPSS and R software.</p><p><strong>Results: </strong>Compared with ACT, NACT alone did not significantly impact survival (hazard ratio [HR] 0.834, 95% confidence interval [CI] 0.392-1.774, p = 0.638), whereas ACT + NACT (HR 0.389, 95% CI 0.169-0.895, p = 0.026) and ICT + ACT + NACT (HR 0.466, 95% CI 0.246-0.883, p = 0.019) positively affected UC prognosis. However, when compared with the combination of ACT + NACT, the combination of ICT + ACT + NACT did not show a statistically significant effect (HR 1.198, 95% CI 0.427-3.362, p = 0.731). Compared with no chemotherapy, ACT reduced renal UC survival (HR 1.430, 95% CI 1.105-1.850, p = 0.007) but improved ureter (HR 0.460, 95% CI 0.232-0.915, p = 0.027) and bladder UC survival (HR 0.605, 95% CI 0.466-0.785, p < 0.001).</p><p><strong>Conclusions: </strong>Prognosis after chemotherapy varied depending on different tumor locations. ACT reduced the prognosis of renal UC patients but elevated the prognosis of ureter UC and bladder UC patients. Distinct chemotherapy protocols have also yielded varying prognostic outcomes. For UC patients, the combination of ACT + NACT merits consideration in order to achieve better prognostic outcomes than the use of ACT or NACT alone. 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引用次数: 0
摘要
导言：为了提高尿路上皮癌（UC）的预后，临床医生将手术与术中（ICT）、新辅助（NACT）或辅助化疗（ACT）相结合；然而，对它们单独和综合影响的研究各不相同。此外，对ACT和NACT联合使用的研究较少。目的：本研究旨在利用监测、流行病学和最终结果（SEER）数据库评估这些化疗方案对UC预后的影响，特别是ACT + NACT的有效性。方法：分析2019 - 2021年45211例UC病例，重点分析肾脏、输尿管、膀胱、前列腺和尿道UC。采用SPSS和R软件进行Cox模型校正生存曲线和多变量Cox回归分析。结果：与ACT相比，单独使用NACT对生存无显著影响（风险比[HR] 0.834, 95%可信区间[CI] 0.392 ~ 1.774, p = 0.638），而ACT + NACT（风险比[HR] 0.389, 95% CI 0.169 ~ 0.895, p = 0.026）和ICT + ACT + NACT（风险比[HR] 0.466, 95% CI 0.246 ~ 0.883, p = 0.019）对UC预后有积极影响。但与ACT + NACT联合治疗相比，ICT + ACT + NACT联合治疗没有统计学意义（HR 1.198, 95% CI 0.427-3.362, p = 0.731）。与未化疗相比，ACT降低了肾脏UC的生存率（HR 1.430, 95% CI 1.105 ~ 1.850, p = 0.007），但改善了输尿管UC的生存率（HR 0.460, 95% CI 0.233 ~ 0.915, p = 0.027）和膀胱UC的生存率（HR 0.605, 95% CI 0.466 ~ 0.785, p）。ACT降低了肾性UC患者的预后，但提高了输尿管和膀胱UC患者的预后。不同的化疗方案也产生了不同的预后结果。对于UC患者，为了获得比单独使用ACT或NACT更好的预后，ACT + NACT联合用药值得考虑。UC患者可能没有必要采用ICT。
Improving Urothelial Carcinoma Outcomes: The Powerful Combination of Neoadjuvant and Adjuvant Chemotherapy in the Perioperative Period.
Introduction: To enhance urothelial carcinoma (UC) prognosis, clinicians combine surgery with intraoperative (ICT), neoadjuvant (NACT), or adjuvant chemotherapy (ACT); however, studies on their individual and combined effects vary. Furthermore, studies on the combined use of ACT and NACT are scarce.
Objective: This study aimed to assess the impact of these chemotherapy regimens on UC prognosis, particularly the effectiveness of ACT + NACT, using the Surveillance, Epidemiology, and End Results (SEER) database.
Methods: We analyzed 45,211 UC cases from 2019 to 2021, focusing on renal, ureter, bladder, prostate, and urethra UC. Cox model-adjusted survival curves and multivariable Cox regression were performed using SPSS and R software.
Results: Compared with ACT, NACT alone did not significantly impact survival (hazard ratio [HR] 0.834, 95% confidence interval [CI] 0.392-1.774, p = 0.638), whereas ACT + NACT (HR 0.389, 95% CI 0.169-0.895, p = 0.026) and ICT + ACT + NACT (HR 0.466, 95% CI 0.246-0.883, p = 0.019) positively affected UC prognosis. However, when compared with the combination of ACT + NACT, the combination of ICT + ACT + NACT did not show a statistically significant effect (HR 1.198, 95% CI 0.427-3.362, p = 0.731). Compared with no chemotherapy, ACT reduced renal UC survival (HR 1.430, 95% CI 1.105-1.850, p = 0.007) but improved ureter (HR 0.460, 95% CI 0.232-0.915, p = 0.027) and bladder UC survival (HR 0.605, 95% CI 0.466-0.785, p < 0.001).
Conclusions: Prognosis after chemotherapy varied depending on different tumor locations. ACT reduced the prognosis of renal UC patients but elevated the prognosis of ureter UC and bladder UC patients. Distinct chemotherapy protocols have also yielded varying prognostic outcomes. For UC patients, the combination of ACT + NACT merits consideration in order to achieve better prognostic outcomes than the use of ACT or NACT alone. The adoption of ICT for UC patients may not be necessary.
期刊介绍：
The Annals of Surgical Oncology is the official journal of The Society of Surgical Oncology and is published for the Society by Springer. The Annals publishes original and educational manuscripts about oncology for surgeons from all specialities in academic and community settings.
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