SUO 2017: Pathologic Downstaging Following Neoadjuvant Chemotherapy In Patients With High-risk Upper Tract Urothelial Carcinoma

Washington, DC ( Introduction: High-risk upper tract urothelial carcinoma (UTUC) is an aggressive disease associated with poor survival outcomes. Limited retrospective data supports the use of neoadjuvant chemotherapy (NAC) prior to radical nephroureterectomy (RNU). In this study, the authors attempted to evaluate the incidence of pathologic down-staging in patients with high-risk UTUC who underwent NAC followed by extirpative surgery to validate prior findings.

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