MP82-10 PREDICTIVE MODEL FOR SYSTEMIC RECURRENCE FOLLOWING CISPLATIN-BASED NEOADJUVANT CHEMOTHERAPY AND RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA

Abstract

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP82)1 Apr 2020MP82-10 PREDICTIVE MODEL FOR SYSTEMIC RECURRENCE FOLLOWING CISPLATIN-BASED NEOADJUVANT CHEMOTHERAPY AND RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA Rashed Ghandour*, Yuval Freifeld, Joseph Cheaib, Nirmish Singla, Xiaosong Meng, Alexander Kenigsberg, Aditya Bagrodia, Solomon Woldu, Firas Petros, Jay Raman, Philip Pierorazio, Surena Matin, and Vitaly Margulis Rashed Ghandour*Rashed Ghandour* More articles by this author , Yuval FreifeldYuval Freifeld More articles by this author , Joseph CheaibJoseph Cheaib More articles by this author , Nirmish SinglaNirmish Singla More articles by this author , Xiaosong MengXiaosong Meng More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Aditya BagrodiaAditya Bagrodia More articles by this author , Solomon WolduSolomon Woldu More articles by this author , Firas PetrosFiras Petros More articles by this author , Jay RamanJay Raman More articles by this author , Philip PierorazioPhilip Pierorazio More articles by this author , Surena MatinSurena Matin More articles by this author , and Vitaly MargulisVitaly Margulis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000974.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Based on the established benefit of neoadjuvant chemotherapy (NAC) in urothelial cancer of the bladder, NAC is increasingly used prior to radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Systemic recurrence (SR) following RNU carries a dismal prognosis. We sought to determine factors that predict higher risk of SR following NAC and RNU. METHODS: We retrospectively evaluated data from a multi-center database of UTUC patients who received cisplatin-based NAC followed by RNU. Final pathology was dichotomized into less than pT2 versus pT2 or more. SR was defined as any recurrence outside the urinary tract. Univariable (UV) and multivariable (MV) logistic regression analyses were performed to identify factors associated with SR. Factors identified on UV analysis as significant for recurrence were grouped into 3 groups (0, 1-2, 3 risk factors) and evaluated for recurrence-free survival using the Kaplan-Meier analysis and log-rank test. RESULTS: 110 patients received cisplatin-based NAC prior to RNU between 2004 and 2018. Median age was 67.0 years [IQR=61-73.3], 59 (53.6%) and 51 (46.4%) patients received MVAC and GC, respectively. Final pathological stage was <T2 in 59 (53.6%) patients and ≥T2 in 51 (46.4) patients. Overall 23.6% (26/110) had SR, 24 of those were within 19 months. On UV analysis, final specimen variables such as pT2 or more, lymphovascular invasion (LVI), nodal involvement, and tumor size were all associated with higher SR. MV model including the identified risk factors had an area under the curve of 0.86 (95% CI [0.77-0.95]; p<0.001) suggesting high predictive ability, with pT≥2 OR=5.3 (95% CI 1.24-22.7; p=0.024). Stratifying according to number of risk factors, the 2-year recurrence-free survival was 97.4%, 72.7%, and 26.7% for 0, 1-2 and, 3 risk factors respectively (log-rank <0.001). CONCLUSIONS: We created a predictive model for SR following NAC and RNU for UTUC to direct decision-making after surgery. A pathology of muscle invasive UTUC, when combined with LVI and nodal involvement, can predict the risk of SR with high accuracy. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1249-e1250 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rashed Ghandour* More articles by this author Yuval Freifeld More articles by this author Joseph Cheaib More articles by this author Nirmish Singla More articles by this author Xiaosong Meng More articles by this author Alexander Kenigsberg More articles by this author Aditya Bagrodia More articles by this author Solomon Woldu More articles by this author Firas Petros More articles by this author Jay Raman More articles by this author Philip Pierorazio More articles by this author Surena Matin More articles by this author Vitaly Margulis More articles by this author Expand All Advertisement PDF downloadLoading ...