The study aimed to investigate the impact of adjuvant chemotherapy on time to recurrence (TTR) and overall survival (OS) in patients with histologic variants of upper tract urothelial carcinoma (VUTUC) following radical nephroureterectomy (RNU). A retrospective review of 131 VUTUC patients' medical records, from a pool of 368 non-metastatic localized or locally advanced UTUC cases, treated at a single tertiary referral center between January 2011 and January 2021. The intervention was adjuvant chemotherapy administration post-RNU. TTR and OS were evaluated using Kaplan-Meier and Cox proportional hazard regression, covariates adjusted for age, postoperative GFR, history of neoadjuvant chemotherapy, T and N stage with stabilized inverse probability of treatment weighting (sIPTW). The application of adjuvant chemotherapy showed a significant extension in TTR ( = .01), but no substantial impact on OS ( = .19) after sIPTW adjustment for covariates. Multivariate analysis revealed adjuvant chemotherapy, tumor size, and lymphovascular invasion as significant prognostic factors for TTR. In contrast, only tumor size and perineural invasion were significant for OS. Adjuvant chemotherapy reduced the progression risk in certain VUTUC subtypes (squamous or glandular/micropapillary), but not in sarcomatoid variants. Adjuvant chemotherapy appears to improve TTR, albeit without a significant effect on OS, in nonmetastatic localized and locally advanced VUTUC patients post-RNU. While beneficial to some VUTUC subtypes, it did not yield significant advantages for sarcomatoid variants. Despite adjustments for known confounders, the study's findings may be subject to potential selection bias and unmeasured confounding factors.

中文翻译：

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根治性肾输尿管切除术后辅助化疗对变异组织学上尿路尿路上皮癌的有效性：单中心经验的稳定逆概率治疗权重分析

该研究旨在探讨根治性肾输尿管切除术（RNU）后辅助化疗对上尿路尿路上皮癌（VUTUC）组织学变异患者的复发时间（TTR）和总生存期（OS）的影响。对 2011 年 1 月至 2021 年 1 月期间在单一三级转诊中心接受治疗的 368 名非转移性局部或局部晚期 UTUC 病例的 131 名 VUTUC 患者的病历进行回顾性审查。干预措施是 RNU 后辅助化疗。使用 Kaplan-Meier 和 Cox 比例风险回归、根据年龄、术后 GFR、新辅助化疗史、T 和 N 分期以及稳定的治疗权重逆概率 (sIPTW) 调整协变量来评估 TTR 和 OS。辅助化疗的应用显示 TTR 显着延长 (= .01)，但在协变量 sIPTW 调整后对 OS (= .19) 没有实质性影响。多变量分析显示辅助化疗、肿瘤大小和淋巴管侵犯是 TTR 的重要预后因素。相比之下，只有肿瘤大小和神经周围侵犯对 OS 具有重要意义。辅助化疗可降低某些 VUTUC 亚型（鳞状或腺体/微乳头状）的进展风险，但不能降低肉瘤样变体的进展风险。对于 RNU 后的非转移性局部和局部晚期 VUTUC 患者，辅助化疗似乎可以改善 TTR，尽管对 OS 没有显着影响。虽然对某些 VUTUC 亚型有益，但它对肉瘤样变体并没有产生显着的优势。尽管对已知的混杂因素进行了调整，但该研究的结果可能会受到潜在的选择偏差和未测量的混杂因素的影响。