EAU 2017: Perioperative chemotherapy does not improve disease free survival in upper tract urothelial carcinoma: a population based analysis

London, England (UroToday.com) Upper tract urothelial carcinoma (UTUC) is a rare disease, accounting for less than 5% of all urothelial cancers and with a peak incidence in the 8th and 9th decade. The role of perioperative chemotherapy remains poorly defined. Current practice in UTUC is derived from evidence related to muscle-invasive bladder cancer, where it has been shown to have a positive effect on cancer specific survival (CSS).

The authors attempted to evaluate the usage and outcomes of perioperative chemotherapy in non-metastatic UTUC patients over the past decade using the Surveillance, Epidemiology and End Results (SEER) cancer registry.
All adult patients diagnosed with non-metastatic UTUC between 2004 and 2013 were included.

Multivariate regression analyses were performed to determine predictors of chemotherapy usage, CSS and overall mortality (OM).
The total cohort included almost 10,000 patients, of which only ~16% received chemotherapy, including only 35% of high-risk patients (>pT2 or N1). From 2004 to 2013, chemotherapy receipt has been increasing steadily in a linear fashion. Treated patients had higher cancer specific mortality (CSM) (21.8% vs. 14.2%, p<0.005).

Predictors of chemotherapy usage included residence in Midwest states, ureteral tumors, higher stage and grade. Predictors of CSM included older age, residence in southern states, higher stage and grade, and receipt of chemotherapy (HR = 1.151, 95% CI: 1.003-1.32, p=0.044). OM was predicted by male gender, older age, ureteral tumor, and higher stage. Chemotherapy however, was not found to be a predictor of OM. A subset analysis of patients younger than 65 showed similar predictors, while in high risk patients chemotherapy receipt did not predict CSM or OM.

In this large contemporary non-metastatic UTUC cohort, chemotherapy usage was quite infrequent but was shown to increase steadily. While CSM was not affected by perioperative chemotherapy in high-risk patients, it was worse in younger patients (<65).
The study was limited by its retrospective nature and lack of data on chemotherapy timing (neoadjuvant/adjuvant), although it is safe to assume that the majority of patients received it in the adjuvant setting.

The main take home messages include the fact that chemotherapy is used in about a 1/7 of UTUC patients and a 1/3 of high risk patients, although it has become more prevalent in recent years. Additionally the study shows that chemotherapy predicted higher CSM, while mostly not affecting OM, even in high risk patients.

Speaker(s): Goldberg, H., Toronto (CA)

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto
Twitter: @GoldbergHanan

at the #EAU17 - March 24-28, 2017- London, England