Neoadjuvant Versus Adjuvant Therapy for Clinical Node-Positive UTUC

For patients with clinical node-positive (cN+) upper tract urothelial carcinoma (UTUC), neoadjuvant chemotherapy (NAC) may lead to improved survival outcomes compared with adjuvant chemotherapy (AC), according to an analysis of the ROBotic surgery for Upper Tract Urothelial cancer STudy (ROBUUST) registry.

Results of the analysis were presented at the 2024 American Urological Association Annual Meeting.

Being cN+ is considered a negative prognostic factor in patients with UTUC. While AC following robotic nephroureterectomy (RNU) is regarded as standard of care for high-risk localized and locoregional disease as a result of the POUT study, NAC may be an effective treatment option for patients to avoid renal function decline.

Margaret F. Meagher, MD, and colleagues sought to compare outcomes of NAC versus AC in cN+ UTUC. They performed a retrospective analysis of 102 patients who underwent RNU from the ROBUUST 2.0 database. Patients were categorized as those who received NAC (n=53) and those who received AC (n=49).

The primary outcome of the study was all-cause mortality, while secondary outcomes included cancer-specific mortality and recurrence.

Researchers used multivariable Cox regression analysis to identify predictive factors for these end points. Kaplan-Meier analysis was performed to analyze 5-year overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS).

After a median follow-up of 17 months, Dr. Meagher and colleagues reported that receipt of NAC was associated with improved all-cause mortality (hazard ratio [HR], 0.39; P=.019) and cancer-specific mortality (HR, 2.44; P=.042). Multivariable analysis further showed that NAC was not associated with recurrence (P=.958).

Importantly, Kaplan-Meier analysis highlighted significantly greater 5-year OS (65% vs 37%; P=.004), CCS (63% vs 29%; P=.010), and RFS (50% vs 17%; P=.046) for NAC compared with AC, respectively.

“In the setting of cN+ disease, NAC was associated with improved survival outcomes,” study authors concluded. “Our findings suggest that presurgical systemic therapy may be preferred in the subpopulation of patients who are cN+ prior to RNU,” adding that further investigation is needed to confirm this association.