PD18-04 ARE SURVIVAL OUTCOMES AFTER NEOADJUVANT CHEMOTHERAPY SUPERIOR TO THOSE AFTER UPFRONT RADICAL NEPHROURETERECTOMY FOR NODE-POSITIVE UPPER TRACT UROTHELIAL CARCINOMA? RESULTS OF A MULTI-CENTER COHORT STUDY

Abstract

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD18)1 Apr 2020PD18-04 ARE SURVIVAL OUTCOMES AFTER NEOADJUVANT CHEMOTHERAPY SUPERIOR TO THOSE AFTER UPFRONT RADICAL NEPHROURETERECTOMY FOR NODE-POSITIVE UPPER TRACT UROTHELIAL CARCINOMA? RESULTS OF A MULTI-CENTER COHORT STUDY Keisuke Shigeta*, Kazuhiro Matsumoto, Nobuyuki Tanaka, Yota Yasumizu, Toshikazu Takeda, Shinya Morita, Takeo Kosaka, Ryuichi Mizuno, Eiji Kikuchi, Hiroshi Asanuma, and Mototsugu Oya Keisuke Shigeta*Keisuke Shigeta* More articles by this author , Kazuhiro MatsumotoKazuhiro Matsumoto More articles by this author , Nobuyuki TanakaNobuyuki Tanaka More articles by this author , Yota YasumizuYota Yasumizu More articles by this author , Toshikazu TakedaToshikazu Takeda More articles by this author , Shinya MoritaShinya Morita More articles by this author , Takeo KosakaTakeo Kosaka More articles by this author , Ryuichi MizunoRyuichi Mizuno More articles by this author , Eiji KikuchiEiji Kikuchi More articles by this author , Hiroshi AsanumaHiroshi Asanuma More articles by this author , and Mototsugu OyaMototsugu Oya More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000861.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The indications of neoadjuvant chemotherapy (NAC) for lymph node-positive upper tract urothelial carcinoma (UTUC) have not been investigated regarding improved survival outcomes. Our specific aim was to compare the clinical outcomes of clinically node-positive UTUC patients who were treated by NAC followed by radical nephroureterectomy (RNU) or upfront RNU followed by adjuvant chemotherapy (AC). METHODS: Among 996 UTUC patients, 89 patients were diagnosed with UTUC with clinical nodal involvement and received either NAC before RNU or AC after upfront RNU. Standard regional lymph node dissection based on the anatomic template was performed on all patients. Log-rank test and Cox proportional hazard models were employed to evaluate the impact of chemotherapy modality on the oncological outcomes. RESULTS: The median age was 71 (range 45-88) years old and the median follow-up time was 29.8 (range 4.0-134.4) months. Of the cohort, 36 (40.4%) patients received NAC followed by RNU, whereas 53 (59.6%) patients underwent RNU directly with subsequent AC. Fifty-nine (66.3%) patients had disease recurrence and 57 (64.0%) patients died from cancer-related death. Twenty-eight (31.5%) patients exhibited downstaging from preoperative stage to pathological stage. According to Kaplan-Meier analysis, the 1- year and 2-year RFS were 67.9% and 47.0%, respectively, in the NAC+RNU group, which were significantly higher than those in the RNU+AC group (43.9% and 24.6%, respectively, p=0.006) (Figure 1a). Multivariate analysis revealed that tumor size ≥3 cm (HR=2.11, p=0.018), clinical T4 (HR=2.41, p<0.001), and GC regimen (HR=1.94 p<0.001) were independent risk factors for disease recurrence, whereas NAC followed by RNU was an independent factor for improved RFS((HR=0.41, p=0.003). Moreover, the 1-year and 2-year CSS were 80.5% and 64.2%, respectively, in the NAC+RNU group, which were than those in the RNU+AC group (68.6% and 48.2%, respectively, p=0.016) (Figure 1b). Multivariate analysis also indicated that NAC followed by RNU remained as an independent factor for improving CSS (HR=0.51, p=0.025). CONCLUSIONS: For node-positive UTUC patients, NAC followed by RNU is more advantageous than upfront RNU with AC. Source of Funding: none. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e376-e376 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Keisuke Shigeta* More articles by this author Kazuhiro Matsumoto More articles by this author Nobuyuki Tanaka More articles by this author Yota Yasumizu More articles by this author Toshikazu Takeda More articles by this author Shinya Morita More articles by this author Takeo Kosaka More articles by this author Ryuichi Mizuno More articles by this author Eiji Kikuchi More articles by this author Hiroshi Asanuma More articles by this author Mototsugu Oya More articles by this author Expand All Advertisement PDF downloadLoading ...