AUA 2018: Incidence of Lower Pathologic Stage in Patients Treated with Neoadjuvant Chemotherapy for High-Risk Upper Tract Urothelial Carcinoma

San Francisco, CA ( It is known that high-risk upper tract urothelial carcinoma (UTUC) has been associated with poor survival outcomes. There are limited retrospective data supporting the use of neoadjuvant chemotherapy prior to radical nephroureterectomy (RNU). In this study, the authors evaluated the change in pathologic stage distribution in patients with high-risk UTUC who underwent neoadjuvant chemotherapy followed by RNU to validate prior findings.

This was a retrospective analysis of 240 patients at The Johns Hopkins Hospital between 2003 and 2017 with UTUC. Patients with biopsy-proven high-grade disease with a visible lesion on cross-sectional imaging were offered neoadjuvant chemotherapy prior to RNU. A control group comprised of a time-matched cohort of patients with biopsy proven, high-grade disease underwent extirpative surgery alone. 

Overall, there were 32 patients in the study group and 208 patients in the control group. Baseline demographic data was similar between cohorts. There was a significantly lower incidence of lower pathologic stage in the study group compared to the control group

(P<0.001). The incidence of patients with pT2 disease or higher was significantly lower in patients treated with neoadjuvant chemotherapy (37.5% vs. 59.6%; P=0.02). There was a 46.5% reduction in the incidence of pT3 disease or higher in study group patients without clinically node positive or low-volume metastatic disease (25.9% vs. 48.4%; P=0.04) (See figure below). A 9.4% complete remission rate was observed in patients undergoing neoadjuvant chemotherapy.

Pathologic Tumor Stage

The authors concluded that patients with high-risk UTUC treated with neoadjuvant chemotherapy are noted to have lower pathologic stage distribution compared to RNU alone.

Presented by: Ross Liao Johns Hopkins School of Medicine, Baltimore, MD
Co-Authors: Mohit Gupta, Zeyad Schwen, Hiten Patel, Max Kates, Michael Johnson, Noah Hahn, David McConkey, Trinity Bivalacqua, Phillip Pierorazio, Baltimore, MD

Written by:  Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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