To assess the impact of neoadjuvant and adjuvant chemotherapy on survival outcomes, within a large multicenter cohort of Upper tract urothelial carcinoma patients treated with Nephroureterectomy.
A multicenter retrospective analysis utilizing the Robotic surgery for Upper Tract Urothelial Cancer Study registry was performed. Baseline, preoperative, perioperative, and pathologic variables of three groups of patients receiving surgery only, neoadjuvant or adjuvant chemotherapy were compared. Categorical and continuous variables among the three subgroups were compared with Chi square and ANOVA tests. The impact of perioperative chemotherapy on survival outcomes was assessed with the Kaplan Meier method. Univariable and multivariable Cox regression analyses were performed to identify predictors of survival.
Overall, 1,994 patients were included. Overall and Clavien grade ≥3 complications rates were comparable among the three subgroups (p = 0.65 and p = 0.92). At Kaplan Meier analysis, neoadjuvant chemotherapy significantly improved cancer-specific survival (p = 0.03) and overall survival (p = 0.03) probabilities of patients with cT ≥ 3 tumors and of those with positive cN (p = 0.03 and p = 0.02). On multivariable analysis, neoadjuvant chemotherapy was independently associated with an improvement of cancer-specific survival in cT ≥ 3 patients (HR 0.44; p = 0.04), and of both cancer-specific survival (HR 0.50; p = 0.03) and overall survival (HR 0.53; p = 0.02) probabilities in positive cN patients.
This large multicenter retrospective analysis suggests significant survival benefit in Upper tract urothelial carcinoma patients with either locally advanced or clinically positive nodes disease receiving neoadjuvant chemotherapy. These findings can be regarded as "hypothesis generating", stimulating future trials focusing on such advanced stages.
World journal of urology. 2024 Oct 12*** epublish ***
Gabriele Tuderti, Riccardo Mastroianni, Flavia Proietti, Zhenjie Wu, Linhui Wang, Antonio Franco, Firas Abdollah, Marco Finati, Matteo Ferro, Marco Tozzi, Francesco Porpiglia, Enrico Checcucci, Raj Bhanvadia, Vitaly Margulis, Stephan Bronimann, Nirmish Singla, Kevin Hakimi, Ithaar H Derweesh, Andreas Correa, Emma Helstrom, Dinno F Mendiola, Mark L Gonzalgo, Reuben Ben David, Reza Mehrazin, Sol C Moon, Soroush Rais-Bahrami, Courtney Yong, Chandru P Sundaram, Antonio Tufano, Sisto Perdonà, Alireza Ghoreifi, Farshad S Moghaddam, Hooman Djaladat, Francesco Ditonno, Alessandro Antonelli, Riccardo Autorino, Giuseppe Simone
Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy. ., Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy., Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China., Department of Urology, Rush University, Chicago, IL, USA., Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA., Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy., Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy., Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA., The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA., Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, USA., Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA., Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA., Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA., Department of Urology, Indiana University, Indianapolis, IN, USA., Uro-Gynecological Department, Fondazione "G. Pascale" IRCCS, Naples, Italy., Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, USA., Department of Urology, University of Verona, Verona, Italy.