Methods: The authors performed a retrospective analysis of 240 patients at The Johns Hopkins Hospital with biopsy-proven, high-risk UTUC. The study group was comprised of patients who underwent NAC prior to RNU from 2003 to 2017. The control group was comprised of a time-matched cohort of patients who underwent initial surgery without NAC.
Results: There were 32 patients in the study group and 208 patients in the control group. Baseline demographic data was similar between both cohorts. There was significant pathologic down-staging in the study group compared to the control group (P<0.001). The incidence of patients with pT2 disease or higher was significantly reduced in patients treated with NAC (59.6% vs. 37.5%; P=0.022). There was also a 54.5% reduction in the incidence of pT3 disease or higher in patients without clinically-node positive or low-volume metastatic disease (p=0.01). A 9.4% complete remission rate was observed in all patients undergoing NAC.
Conclusion: Although the study group was comprised of a relatively small number of patients, and although the follow-up period was short, the authors claim that NAC was associated with a significant rate of down-staging. This data adds to the growing body of evidence demonstrating improved outcomes in patients with high-risk UTUC who undergo NAC followed by RNU.
Presented by: Ross Liao, Batimore, USA
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC