AUA 2016: Contemporary utilization trends of systemic chemotherapy for Upper Tract Urothelial Carcinoma (UTUC) - Poster Session Highlights

San Diego, CA USA ( Recent meta-analysis of Adjuvant (AT) and Neoadjuvant (NAT) indicated a benefit of either for disease-free survival (Leow et al, Eur Urol 2014). However, currently no consensus exists regarding the use of systemic therapy for surgically treated patients with invasive UTUC.

The group from Fox Chase Cancer Center used National Cancer Database from 1998-2012 to assess temporal trends in utilization of systemic therapy for Stage II-IV UTUC patients and to identify factors that predicted utilization specifically of adjuvant therapy. Kaplan Meier analysis was also performed to compare overall survival between patients receiving any systemic therapy versus those who did not.

Of 7,629 patients identified over the study period, 24.1% of patients surgically treated for stage II-IV UTUC received any systemic therapy (NAT: 1.44%, AT: 19.11%, Unknown treatment: 3.51%). Utilization of any systemic therapy significantly increased from 1998-2012 (20.2% vs. 28.7%, p <0.0001). Following adjustment, patients of increased age were less likely to receive AT, and patients with high grade were more likely to be treated with AT. While no differences in OS were noted in all patients, when restricted to stage III-IV disease, receipt of systemic therapy was significantly associated with improved Overall Survival after adjustment for age, grade, and charlson index (p<0.002).

The group concludes that while utilization of systemic therapy has increased from 1998-2012, less than one third of surgically treated patients for stage II-IV UTUC receive systemic treatment. In addition to unmeasured characteristics (decline of renal function following surgery), the lack of explicit guidelines and prospective studies may contribute to underutilization of AT.


Written By: Mohammed Haseebuddin, MD; Fox Chase Cancer Center, Philadelphia, PA., at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA

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