To analyze utilization and outcomes of cytoreductive surgery (CRS) after systemic chemotherapy in select patients with metastatic upper tract urothelial carcinoma (UTUC).
We identified 1,773 patients with cM1 UTUC from the National Cancer Database who were treated with first-line multiagent chemotherapy from 2004 to 2015. Patients considered surgical candidates based on Charlon-Deyo performance score were stratified into non-surgical versus surgical arms based on receipt of CRS after systemic therapy. Those receiving radiation, immunotherapy, or other types of treatment were excluded. Cox proportional hazard models were used to analyze prognostic factors for overall survival (OS). Propensity-score (PS) matching and inverse probability of treatment weighting (IPTW)-adjusted regression models were used to compare OS.
A total of 1,182 patients were included of which 349 (29.5%) were treated with definitive surgery. Median follow-up was 64 months (95%CI:49.8-79.4) for chemotherapy+surgery versus 61.2 (52.2-78.7) for the chemotherapy-alone arms (p=0.09). Patients treated with surgery were younger and more commonly treated at academic facilities. Patients who received CRS had improved median-OS versus those treated with chemotherapy alone (13.7vs.10.8 months, log-rank p-value<0.001). Predictors of OS were performance score, treatment at academic facility, and performance of CRS. Furthermore, in PS and IPTW-adjusted Cox regression analyses, CRS was associated with significant OS benefit (hazard ratios= 0.61, 95%CI:0.49 - 0.77, and 0.63;0.55-0.72; respectively).
We provide a contemporary report on the survival benefit of CRS after treatment with systemic therapy for M1 UTUC patients. Longitudinal studies are needed to evaluate the role of surgery, when feasible, within multidisciplinary approaches for this relatively, rare disease.
Urology. 2021 Jan 19 [Epub ahead of print]
Grant Pollock, Chiu-Hsieh Hsu, Ken Batai, Benjamin R Lee, Juan Chipollini
University of Arizona, Department of Urology, Tucson, Arizona., University of Arizona, Department of Epidemiology and Biostatistics, Tucson, Arizona., University of Arizona, Department of Urology, Tucson, Arizona. Electronic address: .