Trends in the use of neoadjuvant chemotherapy and oncological outcomes for high-risk upper tract urothelial carcinoma: a multicentre retrospective study.

Abstract

OBJECTIVE:

To evaluate temporal trends in neoadjuvant chemotherapy (NAC) utilisation and outcomes in patients with locally advanced upper tract urothelial carcinoma (UTUC).

PATIENTS AND METHODS:

We included 289 patients from seven hospitals who underwent radical nephroureterectomy (RNU) for locally advanced UTUC (≥cT3 or cN+) between 2000 and 2020. These patients received RNU alone or two to four courses of NAC with either a cisplatin- or carboplatin-based regimen. We evaluated the temporal changes in NAC use and compared the visceral recurrence-free, cancer-specific, and overall survival rates. The effect of NAC on oncological outcomes was examined using multivariate Cox regression analysis with inverse probability of treatment weighting (IPTW) models.

RESULTS:

Of 289 patients, 144 underwent NAC followed by RNU (NAC group) and 145 underwent RNU alone (Control [Ctrl] group). NAC use increased significantly from 19% (2006-2010), 58% (2011-2015), to 79% (2016-2020). Pathological downstaging was significantly higher in the NAC group than in the Ctrl group. The IPTW-adjusted multivariable analyses showed that NAC significantly improved the oncological outcomes in the NAC group compared with the Ctrl group. Moreover, carboplatin-based NAC significantly improved the oncological outcomes in the NAC group compared with the Ctrl group among patients with chronic kidney disease Stage ≥3. There were no significant differences in oncological outcomes between the cisplatin- and carboplatin-based regimens.

CONCLUSIONS:

The use of NAC for high-risk UTUC increased significantly after 2010. Platinum-based short-term NAC followed by immediate RNU may not impede and potentially improves oncological outcomes.

• Authors: Tomoko Hamaya, Shingo Hatakeyama, Toshikazu Tanaka, Yuka Kubota, Kyo Togashi, Shogo Hosogoe, Naoki Fujita, Ayumu Kusaka, Noriko Tokui, Teppei Okamoto, Hayato Yamamoto, Tohru Yoneyama, Takahiro Yoneyama, Yasuhiro Hashimoto, Chikara Ohyama
• Journal: BJU international (BJU Int) Vol. 128 Issue 4 Pg. 468-476 (10 2021) ISSN: 1464-410X [Electronic] England
• PMID: 33484231 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 The Authors BJU International published by John Wiley & Sons Ltd on behalf of BJU International.

Topics

• Aged
• Aged, 80 and over
• Carcinoma, Transitional Cell (drug therapy, surgery)
• Female
• Humans
• Kidney Neoplasms (drug therapy, surgery)
• Male
• Middle Aged
• Neoadjuvant Therapy (statistics & numerical data, trends)
• Nephroureterectomy
• Procedures and Techniques Utilization (trends)
• Retrospective Studies
• Risk Assessment
• Time Factors
• Treatment Outcome
• Ureteral Neoplasms (drug therapy, surgery)