Emerging data suggests improved outcomes in patients receiving neoadjuvant chemotherapy (NAC) prior to radical nephroureterectomy (RNU) for high-risk upper tract urothelial carcinoma. In one of the largest single-center experiences to date, we provide an updated analysis of outcomes of patients receiving NAC followed by RNU.
A retrospective review of patients with high-risk UTUC who received NAC followed by surgery between 2004 to 2017 was conducted. 126 patients were evaluated as part of the analysis. Kaplan-Meier method was used to estimate survival probabilities. Multivariable Cox modeling was used to evaluate for association with outcomes, and the cumulative incidence factor was used for competing risk analysis.
Median OS time was 106 months. 14.3% of patients had a pathologic complete response and 60% were down-staged to ypT0-1 ypN0. The estimated 5 and 10-year DSS rates were 89.8% and 80.6%, respectively. The estimated 5 and 10-year metastasis-free survival rates were 81% and 75.4%, respectively. The estimated 5 and 10-year OS rates were 73.7% and 35.9 %, respectively. Recurrences mainly occurred in lymph nodes and lung at a median time of 15.5 months (IQR 8.9-27). The estimated 5 and 10-year cumulative incidence factor for death from UTUC was 9.5% and 16.1%, respectively. Limitations include retrospective nature and challenge of accurate pre-surgical staging.
NAC prior to RNU in high-risk UTUC shows durable 5 and 10-year OS and DSS rates in a large single-institution series, confirming prior findings in prospective trials and retrospective studies.
Clinical genitourinary cancer. 2021 Dec 24 [Epub ahead of print]
Mehrad Adibi, Barrett McCormick, Minas P Economides, Firas Petros, Lianchun Xiao, Charles Guo, Amishi Shah, Ashish M Kamat, Colin Dinney, Neema Navai, Jianjun Gao, Arlene Siefker-Radtke, Surena F Matin, Matthew T Campbell
Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: ., Division of Internal Medicine, University of Texas Houston, Houston, TX., Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX., Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX., Department of Genitourinary Medical Oncology, The University of Texas MD Anderson, Houston, TX.