- Pathological downstaging after preoperative chemotherapy is associated with improved response and survival in patients with high-risk upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy.
- Chemotherapy regimens and cycles administered showed no association with responses, downstaging, and survival.
Why this matters
- Role of preoperative chemotherapy is not clear in patients with high-risk UTUC.
- 267 patients with high-risk UTUC underwent preoperative chemotherapy and radical nephroureterectomy between 2005 and 2017.
- Funding: Scholarship Foundation of Swiss Urology; European Urology Scholarship Program.
- The median follow-up was 22 months.
- Chemotherapy regimen received:
- Methotrexate, vinblastine, doxorubicin, and cisplatin: 30.7%.
- Gemcitabine and cisplatin: 46.1%.
- Gemcitabine and carboplatin: 9.4%.
- Others: 12.0%.
- 34.1% of patients experienced disease recurrence.
- The pathological complete response and pathological downstaging rates were 10.1% and 44.9%, respectively.
- Pathological downstaging was independently associated with improved:
- Recurrence-free survival: HR, 0.20 (P<.001>
- Cancer-specific survival: HR, 0.19 (P<.001>
- OS: HR, 0.40 (P<.001>
- Observational design.