Analysis of Neoadjuvant Chemotherapy Utilization, Pathologic Response, and Overall Survival in Upper Tract Urothelial Carcinoma

Authors

Vincent E. Xu, Department of Urology, George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address: xuve@gwu.edu.
Oluwafolajimi Adesanya, Department of Urology, University of Illinois Urbana-Champaign, Champaign, IL.
Sarah Azari, Department of Urology, George Washington University School of Medicine and Health Sciences, Washington, DC.
Samita Islam, Department of Urology, George Washington University School of Medicine and Health Sciences, Washington, DC.
Matthew Klein, Department of Urology, Drexel University College of Medicine, Philadelphia, PA.
Arthur Drouaud, Department of Urology, George Washington University School of Medicine and Health Sciences, Washington, DC.
Ryan M. Antar, Department of Urology, George Washington University School of Medicine and Health Sciences, Washington, DC.
Phat Chang, Department of Urology, George Washington University School of Medicine and Health Sciences, Washington, DC.
Armine Smith, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
Michael J. Whalen, Department of Urology, George Washington University School of Medicine and Health Sciences, Washington, DC.

Document Type

Journal Article

Publication Date

12-1-2024

Journal

Clinical genitourinary cancer

Volume

22

Issue

6

DOI

10.1016/j.clgc.2024.102224

Keywords

Perioperative chemotherapy; Radical nephroureterectomy; Regionalization of care; Socioeconomic disparities; Systemic therapy

Abstract

INTRODUCTION: Upper tract urothelial carcinoma (UTUC) is a rare malignancy with poor prognosis. Radical nephroureterectomy (RNU) remains the standard treatment for high-risk UTUC. Considering the decline in renal function with RNU and results from prospective trials, NAC has emerged as a favored perioperative treatment for chemo-eligible patients with UTUC. However, strong evidence of the efficacy of NAC and predictors for its use are scarce. We aimed to assess trends in NAC utilization and pathologic outcomes and survival with NAC use. METHODS: The National Cancer Database was queried for patients with high-grade cTanyNanyM0 UTUC treated with RNU from 2004 to 2019. Outcomes included overall survival (OS), pathologic response (pR) and pathologic complete response (pCR), defined as ≤pT1pN0/X and pT0pN0/X, respectively. RESULTS: Of 6,645 patients treated with RNU, 209 received RNU NAC. Greater distance from treatment facility decreased the likelihood of receiving NAC. Higher cT stages (OR 1.72, P = .028), cN+ status (OR 7.40, P < .001) and treatment at an academic facility (OR 2.02, P < .001) predicted NAC treatment. NAC was associated with 34.0% pR and 5.3% pCR. In multivariable analysis, patients with pR and pCR had improved OS (HR = 0.176, P < .014). CONCLUSION: We report significant response rates with NAC and improved OS in patients who experienced pR or pCR. Over a 15-year study period, NAC was underutilized, especially in nonacademic settings and among patients living farther from care facilities, underscoring the need for improved regionalization and multidisciplinary approaches in UTUC management.

APA Citation

Xu, Vincent E.; Adesanya, Oluwafolajimi; Azari, Sarah; Islam, Samita; Klein, Matthew; Drouaud, Arthur; Antar, Ryan M.; Chang, Phat; Smith, Armine; and Whalen, Michael J., "Analysis of Neoadjuvant Chemotherapy Utilization, Pathologic Response, and Overall Survival in Upper Tract Urothelial Carcinoma" (2024). GW Authored Works. Paper 6268.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6268

Department

Urology