UTUC: preoperative chemotherapy improves responses and survival

  • Foerster B & al.
  • J Urol
  • 1 Jun 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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>
  • Chemotherapy regimen and number of administered cycles showed no association with pathological responses, pathological downstaging, or survival.

Limitations

  • Observational design.