Survival Benefit of Chemotherapy in Metastatic Upper Tract Urothelial Carcinoma - Expert Commentary

Upper tract urothelial carcinoma (UTUC) is a distinct clinical entity with poor clinical outcomes. A recent paper published by Nazzani et al. in Clinical Genitourinary Cancer studied the efficacy of chemotherapy in treating non-surgically treated metastatic upper tract urothelial carcinoma (mUTUC) in a large cohort. The investigators identified 539 patients with non-surgically treated mUTUC within the Surveillance, Epidemiology, and End Results database (2004-2014). Of these, 277 (51.4%) received chemotherapy. The investigators compared the overall mortality and cancer-specific mortality in the group that received chemotherapy to the control group. 

The investigators found that chemotherapy use was associated with longer overall survival (9 vs. 2 months; p < .001). They also found lower overall mortality in the chemotherapy group using non-adjusted multivariable Cox regression models (hazard ratio, 0.31; 95% confidence interval, 0.25-0.39; p < .001). Cancer-specific mortality rates were also lower with the use of chemotherapy. Chemotherapy administration independently predicted lower overall mortality (hazard ratio,0.31; 95% confidence interval).

These results confirm the survival benefit of chemotherapy in patients with metastatic upper urinary tract urothelial carcinoma. As we learn more about the biology of the disease, additional UTUC-specific therapeutic strategies will be needed.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine

Nazzani S, et al.  Survival Effect of Chemotherapy in Metastatic Upper Urinary Tract Urothelial Carcinoma. Clin Genitourin Cancer. 2018 Sep 27. pii: S1558-7673(18)30492-0. doi: 10.1016/j.clgc.2018.09.017.
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