AUA 2017: Effectiveness of Adjuvant Chemotherapy After Radical Nephroureterectomy for Locally Advanced and/or Positive Regional Lymph Node Upper Tract Urothelial Carcinoma

Boston, MA ( Dr. Seisen and colleagues presented their population-level analysis of adjuvant chemotherapy after radical nephroureterectomy (RNU) at this morning’s Upper Tract Transitional Cell Carcinoma poster session at the 2017 AUA Annual meeting. Recent randomized controlled trials (RCTs) in the setting of adjuvant RCC have not demonstrated improved outcomes, but whether this is true in the setting of UTUC after RNU has not been assessed at the population level.

To perform this study, the authors used the National Cancer Data Base (2004-2012) to identify 3,253 individuals who received adjuvant chemotherapy or observation after RNU for pT3/T4 and/or pN+ UTUC. Inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier curves and Cox regression analyses were used to compare overall survival (OS) of patients in the two treatment groups. There were 762 (23%) patients that received adjuvant chemotherapy and 2,491 (77%) patients that received observation after RNU. Median OS was significantly longer for adjuvant chemotherapy vs. observation (47, IQR 20-112 vs. 36 IQR 14-99 months; P<0.001). On IPTW-adjusted Cox regression analysis, adjuvant chemotherapy was associated with a significant OS benefit (HR.0.77, 95%CI 0.68-0.88). This benefit was consistent on multiple subgroup analyses including age, gender, Charlson comorbidity index, pathological stage and surgical margin status. The strength of this study is that we will likely have to rely on large population-level analyses to assess survival outcomes, given that the feasibility of an RCT in this setting is unlikely.

In conclusion, the authors have demonstrated an OS advantage for patients with locally advanced UTUC receiving adjuvant chemotherapy, compared to those undergoing observation. It is prudent to note that receipt of adjuvant chemotherapy may be difficult to administer pending renal function post-RNU.

Speaker: Thomas Seisen, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA

Co-Authors: Ross E. Krasnow, Joaquim Bellmunt, Morgan Roupret, Jeffrey J. Leow, Stuart R. Lipsitz, Malte Vetterlein, Mark A. Preston, Nawar Hanna, Adam S. Kibel, Maxine Sun, Toni K. Choueiri, Quoc-Dien Trinh, Steven Lee Chang

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Twitter: @zklaassen_md

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA