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Analysis of Neoadjuvant Chemotherapy Utilization, Pathologic Response, and Overall Survival in Upper Tract Urothelial Carcinoma
Journal article   Open access   Peer reviewed

Analysis of Neoadjuvant Chemotherapy Utilization, Pathologic Response, and Overall Survival in Upper Tract Urothelial Carcinoma

Vincent E. Xu, Oluwafolajimi Adesanya, Sarah Azari, Samita Islam, Matthew Klein, Arthur Drouaud, Ryan M. Antar, Phat Chang, Armine Smith and Michael J Whalen
Clinical genitourinary cancer, v 22(6), 102224
Dec 2024
DOI: https://doi.org/10.1016/j.clgc.2024.102224
PMID: 39418788
Featured in Collection :   UN Sustainable Development Goals @ Drexel
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https://doi.org/10.1016/j.clgc.2024.102224View
Published, Version of Record (VoR) Open

Abstract

Perioperative chemotherapy Radical nephroureterectomy Regionalization of care Socioeconomic disparities Systemic therapy
Upper tract urothelial carcinoma (UTUC) is a rare malignancy with poor prognosis. Radical nephroureterectomy (RNU) remains the standard treatment for high-risk UTUC. Considering the decline in renal function with RNU and results from prospective trials, NAC has emerged as a favored perioperative treatment for chemo-eligible patients with UTUC. However, strong evidence of the efficacy of NAC and predictors for its use are scarce. We aimed to assess trends in NAC utilization and pathologic outcomes and survival with NAC use. The National Cancer Database was queried for patients with high-grade cTanyNanyM0 UTUC treated with RNU from 2004 to 2019. Outcomes included overall survival (OS), pathologic response (pR) and pathologic complete response (pCR), defined as ≤pT1pN0/X and pT0pN0/X, respectively. Of 6,645 patients treated with RNU, 209 received RNU NAC. Greater distance from treatment facility decreased the likelihood of receiving NAC. Higher cT stages (OR 1.72, P = .028), cN+ status (OR 7.40, P < .001) and treatment at an academic facility (OR 2.02, P < .001) predicted NAC treatment. NAC was associated with 34.0% pR and 5.3% pCR. In multivariable analysis, patients with pR and pCR had improved OS (HR = 0.176, P < .014). We report significant response rates with NAC and improved OS in patients who experienced pR or pCR. Over a 15-year study period, NAC was underutilized, especially in nonacademic settings and among patients living farther from care facilities, underscoring the need for improved regionalization and multidisciplinary approaches in UTUC management. This study evaluated neoadjuvant chemotherapy (NAC) utilization and outcomes for patients with upper tract urothelial carcinoma (UTUC) in the National Cancer Database. NAC was underutilized, especially for patients at farther, nonacademic centers. NAC use was associated with 5.3% pathologic complete response and improved overall survival in responders. Our findings support NAC benefits and reveal disparities in its use for UTUC. [Display omitted]

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Collaboration types
Domestic collaboration
Web of Science research areas
Oncology
Urology & Nephrology
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