To evaluate temporal trends in neoadjuvant chemotherapy (NAC) utilization and outcomes in patients with locally advanced upper tract urothelial carcinoma (UTUC).
We included 289 patients from seven hospitals who underwent radical nephroureterectomy (RNU) for locally advanced UTUC (≥cT3 or cN+) between 2000 and 2020. These patients received RNU alone or 2-4 courses of NAC with either cisplatin- or carboplatin-based regimen. We evaluated the temporal changes in NAC use and compared the visceral recurrence-free, cancer-specific, and overall survival rates. The effect of NAC on oncological outcomes was examined using multivariate Cox regression analysis with inverse probability of treatment weighting (IPTW) models.
Of 289 patients, 144 underwent NAC followed by RNU (NAC group) and 145 underwent RNU alone (Ctrl group). NAC use increased significantly from 19% (2006-2010), 58% (2011-2015), to 79% (2016-2020). Pathological downstaging was significantly higher in the NAC group than in the Ctrl group. IPTW-adjusted multivariable analyses showed that NAC significantly improved the oncological outcomes in the NAC group compared with the Ctrl group. Moreover, carboplatin-based NAC significantly improved the oncological outcomes in the NAC group compared with the Ctrl group among patients with chronic kidney disease stage ≥3. There were no significant differences in oncological outcomes between the cisplatin- and carboplatin-based regimens.
NAC use for high-risk UTUC increased significantly after 2010. Platinum-based short-term NAC followed by immediate RNU may not impede and potentially improves oncological outcomes.
BJU international. 2021 Jan 23 [Epub ahead of print]
Tomoko Hamaya, Shingo Hatakeyama, Toshikazu Tanaka, Yuka Kubota, Kyo Togashi, Shogo Hosogoe, Naoki Fujita, Ayumu Kusaka, Noriko Tokui, Teppei Okamoto, Hayato Yamamoto, Tohru Yoneyama, Takahiro Yoneyama, Yasuhiro Hashimoto, Chikara Ohyama
Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan., Department of Urology, Odate Municipal General Hospital, Odate, Japan., Department of Glycotechnology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.