Impact of high-intensity local treatment on overall survival in stage IV upper tract urothelial carcinoma.

To investigate the impact of high-intensity local treatment (LT) on overall survival (OS) in patients with stage IV upper tract urothelial carcinoma (UTUC).

Within the National Cancer Database, we identified 7,357 patients diagnosed with stage IV UTUC from 2004 to 2015.

Patients who underwent high-intensity LT, defined as radical surgery of the primary tumor, were compared with those who did not. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. Weighted survival analyses were used to test the association between high-intensity LT and OS. Multivariable Cox model was used to assess for independent predictors of OS. Sensitivity analysis was used to account for possible biases.

Among stage IV patients, 10.6% (n = 779) had locally advanced disease (T4), 32.6% (n = 2,399) had node-positive disease (N+) and 56.8% (N = 4,179) had distant metastases (M+). Fewer than half of the patients underwent high-intensity LT (n = 2,908, 39.5%) while the remainder did not. On IPTW-adjusted survival analysis, high-intensity LT was associated with a prolonged OS (11.17 months [IQR, 5.19 to 24.28] months vs. 6.18 months [IQR, 2.27 to 14.49], P ≤ 0.001). A similar benefit was seen on adjusted survival analyses for each stage IV subgroup, defined according to TNM characteristics. The survival benefit was confirmed at sensitivity analysis.

High-intensity LT in balanced cohorts of patients with stage IV UTUC is associated with prolonged OS including those with locally advanced (T4), node-positive (N+) or distant metastases (M+).

Urologic oncology. 2021 Mar 15 [Epub ahead of print]

Marco Paciotti, David-Dan Nguyen, Daniele Modonutti, Lorine Haeuser, Stuart Lipsitz, Matthew Mossanen, Adam S Kibel, Giovanni Lughezzani, Quoc-Dien Trinh, Alexander P Cole

Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy., Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medicine, McGill University, Montreal, QC, Canada., Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Surgery, Oncology and Gastroenterology-Urology, University Hospital of Padova, Padova, Italy., Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology and Neuro-Urology, Marien Hospital Herne, Ruhr-University Bochum, Germany., Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA., Department of Urology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy., Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: .

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