Comparison of Pathologic Stage in Patients Treated with and without Neoadjuvant Chemotherapy for High-Risk Upper Tract Urothelial Carcinoma

High-risk upper tract urothelial carcinoma has been associated with poor survival outcomes. Limited retrospective data supports the use of neoadjuvant chemotherapy prior to radical nephroureterectomy.

We evaluated differences in pathologic stage distribution in patients with high-risk upper tract urothelial carcinoma based on the use of neoadjuvant chemotherapy before radical nephroureterectomy to validate prior findings.

We performed a retrospective analysis of 240 patients at The Johns Hopkins Hospital from 2003-2017 with upper tract urothelial carcinoma. Patients with biopsy-proven high-grade disease with a visible lesion on cross-sectional imaging were offered neoadjuvant chemotherapy prior to radical nephroureterectomy. A control group comprised of a time-matched cohort of patients with biopsy-proven high-grade disease underwent extirpative surgery alone. Chi-square and Fisher exact tests were used to evaluate clinical and pathologic variables between cohorts.

There were 32 patients in the study group and 208 patients in the control group. A significantly lower pathologic stage was noted in the study group compared to the control group (P<0.001). The prevalence 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 prevalence 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). A 9.4% complete remission rate was observed in patients undergoing neoadjuvant chemotherapy.

Patients with high-risk upper tract urothelial carcinoma treated with neoadjuvant chemotherapy are noted to have lower pathologic stage distribution compared to those treated with radical nephroureterectomy alone.

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The Journal of urology. 2018 Jan 04 [Epub ahead of print]

Ross S Liao, Mohit Gupta, Zeyad R Schwen, Hiten D Patel, Max Kates, Michael H Johnson, Noah M Hahn, David McConkey, Trinity J Bivalacqua, Phillip M Pierorazio

Department of Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: ., Department of Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., Department of Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; The Greenberg Bladder Cancer Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., Department of Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; The Greenberg Bladder Cancer Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., Department of Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.