TY - JOUR
T1 - Role of neoadjuvant chemotherapy in patients with locally advanced and clinically positive nodes Upper Tract Urothelial Carcinoma treated with Nephroureterectomy
T2 - real-world data from the ROBUUST 2.0 Registry
AU - Tuderti, Gabriele
AU - Mastroianni, Riccardo
AU - Proietti, Flavia
AU - Wu, Zhenjie
AU - Wang, Linhui
AU - Franco, Antonio
AU - Abdollah, Firas
AU - Finati, Marco
AU - Ferro, Matteo
AU - Tozzi, Marco
AU - Porpiglia, Francesco
AU - Checcucci, Enrico
AU - Bhanvadia, Raj
AU - Margulis, Vitaly
AU - Bronimann, Stephan
AU - Singla, Nirmish
AU - Hakimi, Kevin
AU - Derweesh, Ithaar H
AU - Correa, Andreas
AU - Helstrom, Emma
AU - Mendiola, Dinno F
AU - Gonzalgo, Mark L
AU - David, Reuben Ben
AU - Mehrazin, Reza
AU - Moon, Sol C
AU - Rais-Bahrami, Soroush
AU - Yong, Courtney
AU - Sundaram, Chandru P
AU - Tufano, Antonio
AU - Perdonà, Sisto
AU - Ghoreifi, Alireza
AU - Moghaddam, Farshad S
AU - Djaladat, Hooman
AU - Ditonno, Francesco
AU - Antonelli, Alessandro
AU - Autorino, Riccardo
AU - Simone, Giuseppe
N1 - © 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2024/10/12
Y1 - 2024/10/12
N2 - 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.
AB - 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.
KW - Humans
KW - Nephroureterectomy
KW - Neoadjuvant Therapy
KW - Male
KW - Female
KW - Retrospective Studies
KW - Carcinoma, Transitional Cell/surgery
KW - Aged
KW - Ureteral Neoplasms/drug therapy
KW - Kidney Neoplasms/surgery
KW - Registries
KW - Chemotherapy, Adjuvant
KW - Middle Aged
KW - Lymphatic Metastasis
KW - Survival Rate
KW - Neoplasm Staging
KW - Neoadjuvant chemotherapy
KW - Upper tract urothelial carcinoma
KW - Survival
KW - Outcomes
UR - http://www.scopus.com/inward/record.url?scp=85206123224&partnerID=8YFLogxK
U2 - 10.1007/s00345-024-05267-9
DO - 10.1007/s00345-024-05267-9
M3 - Article
C2 - 39395052
SN - 0724-4983
VL - 42
SP - 575
JO - World Journal of Urology
JF - World Journal of Urology
IS - 1
M1 - 575
ER -