Role of neoadjuvant chemotherapy in patients with locally advanced and clinically positive nodes Upper Tract Urothelial Carcinoma treated with Nephroureterectomy: real-world data from the ROBUUST 2.0 Registry

Gabriele Tuderti, Riccardo Mastroianni, Flavia Proietti, Zhenjie Wu, Linhui Wang, Antonio Franco, Firas Abdollah, Marco Finati, Matteo Ferro, Marco Tozzi, Francesco Porpiglia, Enrico Checcucci, Raj Bhanvadia, Vitaly Margulis, Stephan Bronimann, Nirmish Singla, Kevin Hakimi, Ithaar H Derweesh, Andreas Correa, Emma HelstromDinno F Mendiola, Mark L Gonzalgo, Reuben Ben David, Reza Mehrazin, Sol C Moon, Soroush Rais-Bahrami, Courtney Yong, Chandru P Sundaram, Antonio Tufano, Sisto Perdonà, Alireza Ghoreifi, Farshad S Moghaddam, Hooman Djaladat, Francesco Ditonno, Alessandro Antonelli, Riccardo Autorino, Giuseppe Simone

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

PURPOSE: To assess the impact of neoadjuvant and adjuvant chemotherapy on survival outcomes, within a large multicenter cohort of Upper tract urothelial carcinoma patients treated with Nephroureterectomy.

METHODS: A multicenter retrospective analysis utilizing the Robotic surgery for Upper Tract Urothelial Cancer Study registry was performed. Baseline, preoperative, perioperative, and pathologic variables of three groups of patients receiving surgery only, neoadjuvant or adjuvant chemotherapy were compared. Categorical and continuous variables among the three subgroups were compared with Chi square and ANOVA tests. The impact of perioperative chemotherapy on survival outcomes was assessed with the Kaplan Meier method. Univariable and multivariable Cox regression analyses were performed to identify predictors of survival.

RESULTS: Overall, 1,994 patients were included. Overall and Clavien grade ≥3 complications rates were comparable among the three subgroups (p = 0.65 and p = 0.92). At Kaplan Meier analysis, neoadjuvant chemotherapy significantly improved cancer-specific survival (p = 0.03) and overall survival (p = 0.03) probabilities of patients with cT ≥ 3 tumors and of those with positive cN (p = 0.03 and p = 0.02). On multivariable analysis, neoadjuvant chemotherapy was independently associated with an improvement of cancer-specific survival in cT ≥ 3 patients (HR 0.44; p = 0.04), and of both cancer-specific survival (HR 0.50; p = 0.03) and overall survival (HR 0.53; p = 0.02) probabilities in positive cN patients.

CONCLUSIONS: This large multicenter retrospective analysis suggests significant survival benefit in Upper tract urothelial carcinoma patients with either locally advanced or clinically positive nodes disease receiving neoadjuvant chemotherapy. These findings can be regarded as "hypothesis generating", stimulating future trials focusing on such advanced stages.

Original languageEnglish
Article number575
Pages (from-to)575
JournalWorld Journal of Urology
Volume42
Issue number1
DOIs
StatePublished - Oct 12 2024

Keywords

  • Humans
  • Nephroureterectomy
  • Neoadjuvant Therapy
  • Male
  • Female
  • Retrospective Studies
  • Carcinoma, Transitional Cell/surgery
  • Aged
  • Ureteral Neoplasms/drug therapy
  • Kidney Neoplasms/surgery
  • Registries
  • Chemotherapy, Adjuvant
  • Middle Aged
  • Lymphatic Metastasis
  • Survival Rate
  • Neoplasm Staging
  • Neoadjuvant chemotherapy
  • Upper tract urothelial carcinoma
  • Survival
  • Outcomes

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