SUO 2017: Multimodal Treatment With Chemotherapy And Radical Nephroureterectomy May Improve Overall Survival In Patients With Clinically Positive Lymph Node Disease

Washington, DC ( Introduction: Upper tract urothelial carcinoma (UTUC) with clinical lymph node involvement (cN+) is an aggressive disease with a high incidence of mortality. The authors aimed to compare different treatment strategies for this unique entity.

Methods: The authors identified 481 patients with cTanyN1-3M0 UTUC who underwent radical nephroureterectomy (RNU) alone (n=193,40.1%), received chemotherapy alone (n=130, 27.0%), preoperative chemotherapy prior to RNU (41, 8.5%), or postoperative chemotherapy after RNU (n=117, 24.3%). Overall survival (OS) was compared between treatment types using inverse
probability of treatment cox proportional hazards regression models weighted for patient and tumor-specific characteristics.

Results: For the overall cohort, OS at 1, 3 and 5 years was 58.7%, 24.9% and 14.5%, respectively with a median follow-up time of 15.7 months (95% CI=13.9, 17.9 months). The study demonstrated improved OS for preoperative chemotherapy prior to RNU compared to chemotherapy alone (HR=0.61; 95% CI=0.41, 0.92; p=.019) and RNU alone (HR=0.62; 95% CI=0.39, 0.99; p=.044).
Postoperative chemotherapy after RNU was associated with improved OS compared to chemotherapy alone (HR=0.60; 95% CI=0.44, 0.83; p=.002) but not compared to RNU alone (HR=1.09; 95% CI=0.79, 1.46; p=.617). There was no difference in OS for chemotherapy alone vs. RNU alone (HR=0.87; 95% CI=0.65, 1.16; p=.341).

Conclusion: Combined-modality treatment with chemotherapy and RNU is associated with the best results for cN+ UTUC patients.

Presented by: Harry Anastos, New-York, 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

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