RESUMO
INTRODUCTION: Principles of management for upper tract urothelial carcinoma (UTUC) are mostly derived from knowledge of lower tract urothelial carcinoma (LTUC), however recent research indicates that these may be disparate diseases. In this review, we sought to compare the responsiveness of these tumors to similar treatment, platinum-based chemotherapy used in the adjuvant setting. MATERIALS AND METHODS: PubMed, EMBASE, and Web of Science were searched using a systematic search strategy. Disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS) in patients with LTUC and UTUC treated with adjuvant chemotherapy were compared. Review Manager V 5.3 was used for meta-analyses. RESULTS: Adjuvant chemotherapy was associated with improved DFS (HR 0.41, 95%CI 0.31-0.54), CSS (HR 0.29, 95%CI 0.17-0.50) and OS (HR 0.51, 95%CI 0.38-0.70) rates in LTUC. The effectiveness of adjuvant chemotherapy in UTUC was less pronounced with respect to DFS (HR 0.61, 95%CI 0.1-0.93) and CSS (HR 0.70, 95%CI 0.56-0.90) rates, and there was no effect on OS (HR 0.87, 95%CI 0.69-1.10). Differences in CSS and OS were significant (p < 0.0001) in favor of adjuvant chemotherapy for LTUC versus UTUC. CONCLUSION: Despite similar histology, we found significant differences in responsiveness to adjuvant chemotherapy between LTUC and UTUC. This may add to the already growing knowledge that these are disparate diseases. Newer systemic treatments for urothelial carcinoma may prove more effective than platinum-based chemotherapy in the adjuvant setting for UTUC.
RESUMO
BACKGROUND: Functional and oncologic outcomes following radical prostatectomy play a major role in patient satisfaction after treatment. This study was designed to assess the functional and oncologic outcome after robotic assisted radical prostatectomy (RARP) in a single surgeon series of patients. METHODS: A prospectively maintained database of patients undergoing robotic radical prostatectomy in a referral academic center was queried for functional and oncologic outcome. Patients undergoing RARP between 2010 and 2013 were included. Analysis was performed with SPSS and SAS, χ2, Mann-Whitney and t-test were used when appropriate. RESULTS: Overall, 566 patients were included in the analysis. The Trifecta and Pentafecta was 73.9% and 64.1%, respectively. Patients achieving Pentafecta were younger (P<0.001), had lower PSA level (P=0.04), lower Biopsy Gleason (P<0.01), lower risk prostate cancer (P<0.01) and fewer comorbidities (P=0.03). The patients were followed up for a median of 27.4 months in Trifecta and 20.6 months in Pentafecta group. At 12-month follow-up the continence and potency rate was 90.6% and 84.1%, respectively. CONCLUSIONS: Although preoperative counseling for RARP surgery using Pentafecta criteria offers more precise information and reasonable expectations than using the Trifecta, further research is required to prepare a standard reporting outline.