MP18-01 INCIDENCE OF LOWER PATHOLOGIC STAGE IN PATIENTS TREATED WITH NEOADJUVANT CHEMOTHERAPY FOR HIGH-RISK UPPER TRACT UROTHELIAL CARCINOMA

Abstract

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I1 Apr 2018MP18-01 INCIDENCE OF LOWER PATHOLOGIC STAGE IN PATIENTS TREATED WITH NEOADJUVANT CHEMOTHERAPY FOR HIGH-RISK UPPER TRACT UROTHELIAL CARCINOMA Ross Liao, Mohit Gupta, Zeyad Schwen, Hiten Patel, Max Kates, Michael Johnson, Noah Hahn, David McConkey, Trinity Bivalacqua, and Phillip Pierorazio Ross LiaoRoss Liao More articles by this author , Mohit GuptaMohit Gupta More articles by this author , Zeyad SchwenZeyad Schwen More articles by this author , Hiten PatelHiten Patel More articles by this author , Max KatesMax Kates More articles by this author , Michael JohnsonMichael Johnson More articles by this author , Noah HahnNoah Hahn More articles by this author , David McConkeyDavid McConkey More articles by this author , Trinity BivalacquaTrinity Bivalacqua More articles by this author , and Phillip PierorazioPhillip Pierorazio More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.577AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES High-risk upper tract urothelial carcinoma has been associated with poor survival outcomes. Limited retrospective data supports the use of neoadjuvant chemotherapy prior to radical nephroureterectomy. We evaluated the change in pathologic stage distribution in patients with high-risk upper tract urothelial carcinoma who underwent neoadjuvant chemotherapy followed by radical nephroureterectomy to validate prior findings. METHODS We performed a retrospective analysis of 240 patients at The Johns Hopkins Hospital from 2003 to 2017 with upper tract urothelial carcinoma. Patients with biopsy-proven high-grade disease with a visible lesion on cross-sectional imaging were offered neoadjuvant chemotherapy prior to radical nephroureterectomy. A control group comprised of a time-matched cohort of patients with biopsy-proven, high-grade disease underwent extirpative surgery alone. Chi square and Fisher exact tests were used to evaluate clinical and pathologic variables between both cohorts. RESULTS There were 32 patients in the study group and 208 patients in the control group. Baseline demographic data was similar between cohorts. There was a significantly lower incidence of lower pathologic stage in the study group compared to the control group (P<0.001). The incidence of patients with pT2 disease or higher was significantly lower in patients treated with neoadjuvant chemotherapy (37.5% vs. 59.6%; P=0.02). There was a 46.5% reduction in the incidence of pT3 disease or higher in study group patients without clinically-node positive or low-volume metastatic disease (25.9% vs. 48.4%; p=0.04). A 9.4% complete remission rate was observed in patients undergoing neoadjuvant chemotherapy. CONCLUSIONS Patients with high-risk upper tract urothelial carcinoma treated with neoadjuvant chemotherapy are noted to have lower pathologic stage distribution compared to radical nephroureterectomy alone. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e213 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Ross Liao More articles by this author Mohit Gupta More articles by this author Zeyad Schwen More articles by this author Hiten Patel More articles by this author Max Kates More articles by this author Michael Johnson More articles by this author Noah Hahn More articles by this author David McConkey More articles by this author Trinity Bivalacqua More articles by this author Phillip Pierorazio More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...