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Neoadjuvant Chemotherapy for Upper Tract Urothelial Carcinoma

By: Julia Fiederlein
Posted: Thursday, February 4, 2021

In a recent analysis, patients with node-positive upper tract urothelial carcinoma appeared to derive an overall survival benefit from neoadjuvant chemotherapy compared with upfront radical nephroureterectomy. These results were presented by Mohammad Mahmoud, MD, of the Indiana University School of Medicine, Indianapolis, and colleagues during the virtual edition of the 2020 Society of Urologic Oncology (SUO) Annual Meeting (Abstract 81).

“Locoregional nodal involvement predicts poor outcomes in patients with upper tract urothelial carcinoma,” the investigators commented. “The utilization of neoadjuvant chemotherapy has been steadily increasing pertinent to the potential of improving survival for high-risk patients, including those with concerns for node-positive disease.”

Using data from the National Cancer Database from 2006 through 2014, the investigators identified 18,133 patients with high-grade upper tract urothelial carcinoma. A total of 739 patients had node-positive disease; they underwent radical nephroureterectomy with (12.7%) or without (87.9%) neoadjuvant chemotherapy. More patients who underwent upfront radical nephroureterectomy had pathologic nodal involvement than those who received neoadjuvant chemotherapy (87.9% vs. 65.2%; P = .0001). In the absence of neoadjuvant chemotherapy, the relative risk of nodal involvement was 1.35 higher.

Compared with upfront radical nephroureterectomy, treatment with neoadjuvant chemotherapy seemed to be associated with an absolute risk reduction in node positivity of 22.7%; the median durations of overall survival were 24.7 and 10.2 months with and without neoadjuvant chemotherapy, respectively (P = .0009). Among patients who received neoadjuvant chemotherapy, the median duration of overall survival was longer in those who had a complete nodal response than in those who continued to have node-positive disease (36.1 vs. 20.2 months; P = .002). Based on the multivariate analysis, patients who received neoadjuvant chemotherapy seemed to experience improved survival compared with those who underwent upfront radical nephroureterectomy (hazard ratio = 0.65; P = .01).

Disclosure: No information regarding conflicts of interest was provided.



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