Oncologic Outcomes in Patients with Residual Upper Tract Urothelial Carcinoma Following Neoadjuvant Chemotherapy.

Neoadjuvant chemotherapy Oncologic outcomes Upper tract urothelial carcinoma

Journal

European urology oncology
ISSN: 2588-9311
Titre abrégé: Eur Urol Oncol
Pays: Netherlands
ID NLM: 101724904

Informations de publication

Date de publication:
22 Jan 2024
Historique:
received: 08 10 2023
revised: 21 11 2023
accepted: 04 01 2024
medline: 24 1 2024
pubmed: 24 1 2024
entrez: 23 1 2024
Statut: aheadofprint

Résumé

Growing evidence supports the use of neoadjuvant chemotherapy (NAC) for upper tract urothelial carcinoma (UTUC). However, the implications of residual UTUC at radical nephroureterectomy (RNU) after NAC are not well characterized. Our objective was to compare oncologic outcomes for pathologic risk-matched patients who underwent RNU for UTUC who either received NAC or were chemotherapy-naïve. We retrospectively identified 1993 patients (including 112 NAC recipients) who underwent RNU for nonmetastatic, high-grade UTUC between 1985 and 2022 in a large, international, multicenter cohort. We divided the cohort into low-risk and high-risk groups defined according to pathologic findings of muscle invasion and lymph node involvement at RNU. Recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS) estimates were calculated using the Kaplan-Meier method. Multivariable analyses were performed to determine clinical and demographic factors associated with these outcomes. Among patients with low-risk pathology at RNU, RFS, OS, and CSS were similar between the NAC and chemotherapy-naïve groups. Among patients with high-risk pathology at RNU, the NAC group had poorer RFS (hazard ratio [HR] 3.07, 95% confidence interval [CI] 2.10-4.48), OS (HR 2.06, 95% CI 1.33-3.20), and CSS (subdistribution HR 2.54, 95% CI 1.37-4.69) in comparison to the pathologic risk-matched, chemotherapy-naïve group. Limitations include the lack of centralized pathologic review. Patients with residual invasive disease at RNU after NAC represent a uniquely high-risk population with respect to oncologic outcomes. There is a critical need to determine an optimal adjuvant approach for these patients. We studied a large, international group of patients with cancer of the upper urinary tract who underwent surgery either with or without receiving chemotherapy beforehand. We identified a high-risk subgroup of patients with residual aggressive cancer after chemotherapy and surgery who should be prioritized for clinical trials and drug development.

Sections du résumé

BACKGROUND AND OBJECTIVE OBJECTIVE
Growing evidence supports the use of neoadjuvant chemotherapy (NAC) for upper tract urothelial carcinoma (UTUC). However, the implications of residual UTUC at radical nephroureterectomy (RNU) after NAC are not well characterized. Our objective was to compare oncologic outcomes for pathologic risk-matched patients who underwent RNU for UTUC who either received NAC or were chemotherapy-naïve.
METHODS METHODS
We retrospectively identified 1993 patients (including 112 NAC recipients) who underwent RNU for nonmetastatic, high-grade UTUC between 1985 and 2022 in a large, international, multicenter cohort. We divided the cohort into low-risk and high-risk groups defined according to pathologic findings of muscle invasion and lymph node involvement at RNU. Recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS) estimates were calculated using the Kaplan-Meier method. Multivariable analyses were performed to determine clinical and demographic factors associated with these outcomes.
KEY FINDINGS AND LIMITATIONS UNASSIGNED
Among patients with low-risk pathology at RNU, RFS, OS, and CSS were similar between the NAC and chemotherapy-naïve groups. Among patients with high-risk pathology at RNU, the NAC group had poorer RFS (hazard ratio [HR] 3.07, 95% confidence interval [CI] 2.10-4.48), OS (HR 2.06, 95% CI 1.33-3.20), and CSS (subdistribution HR 2.54, 95% CI 1.37-4.69) in comparison to the pathologic risk-matched, chemotherapy-naïve group. Limitations include the lack of centralized pathologic review.
CONCLUSIONS AND CLINICAL IMPLICATIONS CONCLUSIONS
Patients with residual invasive disease at RNU after NAC represent a uniquely high-risk population with respect to oncologic outcomes. There is a critical need to determine an optimal adjuvant approach for these patients.
PATIENT SUMMARY RESULTS
We studied a large, international group of patients with cancer of the upper urinary tract who underwent surgery either with or without receiving chemotherapy beforehand. We identified a high-risk subgroup of patients with residual aggressive cancer after chemotherapy and surgery who should be prioritized for clinical trials and drug development.

Identifiants

DOI: 10.1016/j.euo.2024.01.010 PMID: 38262800
pubmed: 38262800
pii: S2588-9311(24)00035-X
doi: 10.1016/j.euo.2024.01.010
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Auteurs

Sean A Fletcher (SA)

The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Maximilian Pallauf (M)

The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.

Emelia K Watts (EK)

Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.

Kara A Lombardo (KA)

The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Jack A Campbell (JA)

The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Michael E Rezaee (ME)

The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Morgan Rouprêt (M)

GRC 5 Predictive Onco-Uro, Sorbonne University, Department of Urology, Pitie-Salpetriere Hospital, AP-HP, Paris, France.

Stephen A Boorjian (SA)

Department of Urology, Mayo Clinic, Rochester, MN, USA.

Aaron M Potretzke (AM)

Department of Urology, Mayo Clinic, Rochester, MN, USA.

M Reza Roshandel (MR)

Department of Urology, Mayo Clinic, Rochester, MN, USA; Department of Urology, Westchester County Medical Center, Valhalla, NY, USA.

Guillaume Ploussard (G)

Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France.

Hooman Djaladat (H)

Institute of Urology, University of Southern California, Los Angeles, CA, USA.

Alireza Ghoreifi (A)

Institute of Urology, University of Southern California, Los Angeles, CA, USA.

Andrea Mari (A)

Department of Urology, Careggi Hospital, Florence, Italy.

Riccardo Campi (R)

Department of Urology, Careggi Hospital, Florence, Italy.

Zine-Eddine Khene (ZE)

Department of Urology, Rennes University Hospital, Rennes, France.

Jay D Raman (JD)

Department of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.

Eiji Kikuchi (E)

Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan.

Michael Rink (M)

Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Firas Abdollah (F)

Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.

Joost L Boormans (JL)

Department of Urology, Erasmus University Medical Center Rotterdam, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.

Kazutoshi Fujita (K)

Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan.

David D'Andrea (D)

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.

Francesco Soria (F)

Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy.

Alberto Breda (A)

Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain.

Jean Hoffman-Censits (J)

The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.

David J McConkey (DJ)

The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.

Shahrokh F Shariat (SF)

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.

Benjamin Pradere (B)

Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France.

Nirmish Singla (N)

The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA. Electronic address: nsingla2@jhmi.edu.

Classifications MeSH