Perioperative Chemotherapy for Patients With UTUC, Nephroureterectomy

A retrospective analysis by Gabriele Tuderti, MD, and colleagues sought to determine the potential benefits of perioperative chemotherapy for patients with high-grade upper tract urothelial carcinoma (UTUC) who undergo nephroureterectomy.

The study was presented at the European Association of Urology Congress 2024.

Previous trials have revealed that neoadjuvant chemotherapy is an effective treatment path for patients with high-grade UTUC.

In the multicenter analysis, Dr. Tuderti and colleagues evaluated data from the Robotic Surgery for Upper Tract Urothelial Cancer Study registry. They compared the baseline, preoperative, perioperative, and pathologic variables of patients who underwent treatment with nephroureterectomy alone, neoadjuvant chemotherapy, or adjuvant chemotherapy.

Cancer-specific survival (CSS) was evaluated and compared using stage-specific Kaplan-Meier analysis. Investigators compared the categorical and continuous variables of the 3 cohorts with chi-square and analysis of variance tests, respectively.

Across the 3 cohorts, overall complications and Clavien grade ≥3 complication rates were similar (P=.65 and P=.92, respectively). Of the 1994 patients included in the trial, those who received neoadjuvant chemotherapy experienced a higher rate of cT stage ≥3 (P<.001) and cN-positive stage (P<.001).

Following Kaplan-Meier analysis for the cT0-2 group, investigators found no major differences between the 3 cohorts (P=.34). Analysis for the cT ≥3 stage group found that patients who received neoadjuvant chemotherapy experienced an increased CSS rate compared with the other cohorts (P=.03). For cN-positive patients, neoadjuvant chemotherapy also led to an increased CSS rate across cohorts (P=.03).

Researchers concluded that neither neoadjuvant chemotherapy nor adjuvant chemotherapy led to increased CSS compared with surgical treatment alone. They also noted that more data from randomized, controlled trials are expected.

“In specific scenarios, such as locally advanced and clinically node-positive disease, neoadjuvant chemotherapy seems to offer a significant benefit in terms of CSS, with a negligible impact on surgical morbidity,” the researchers wrote.