To assess the impact of neoadjuvant chemotherapy (NAC) on survival outcomes in a contemporary cohort of patients with in upper tract urothelial carcinoma (UTUC).
The National Cancer Data Base was queried from 2004-2015 to identify subjects who underwent nephroureterectomy for UTUC. Kaplan-Meier method with log-rank test was performed to compare all-cause mortality between patients who received preoperative chemotherapy to those who did not at each pathologic (p) TNM stage group: T1-4N0, N+ and M+ disease. Associations for all-cause mortality were identified using an adjusted Cox regression analysis.
A total of 10,315 chemo-eligible subjects were included in the analysis. A total of 296 (2.9%) of patients received NAC prior to NU. Kaplan Meier survival curves of the entire cohort demonstrated an overall survival advantage associated with administration of NAC (p=0.017). Stratified by clinical staging, subjects with non-organ confined tumors had improved overall survival outcomes with NAC administration (p=0.012). On multivariate analysis there was a statistically significant improvement in overall survival between in patients who received NAC. Of patients in the preoperative chemotherapy group who had clinically non-organ confined disease, 27.1% had organ confined disease at time of surgery compared to 1.4% of those who underwent surgery as initial therapy.
In a contemporary cohort of subjects who underwent nephroureterectomy for UTUC, administration of NAC in patients with high grade non-organ confined disease led to higher rates of pathologic downstaging and was associated with improved overall survival.
Urology. 2020 Sep 04 [Epub ahead of print]
Aleem I Khan, Benjamin L Taylor, Bashir Al Hussein Al Awamlh, Lina Posada Calderon, Jonathan Fainberg, Rahmi Elahjji, Jonathan Shoag, Douglas S Scherr
Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY; Weill Cornell Medical College, New York, New York., Weill Cornell Medical College, New York, New York., Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY., Weill Cornell Medical College, New York, New York. Electronic address: .