High Response Rates to Neoadjuvant Chemotherapy in High-Grade Upper Tract Urothelial Carcinoma

Meng, Xiaosong; Chao, Brian; Vijay, Varun; Silver, Hayley; Margolin, Ezra J.; Balar, Arjun Vasant; Taneja, Samir S.; Shah, Ojas; Bjurlin, Marc A.; Anderson, Christopher B.; Huang, William C.

doi:10.1016/j.urology.2019.01.058

Cited by 30 publications

(15 citation statements)

References 23 publications

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“…The accuracy rate of UCP (80.9%) and UCU (83.1%) patients with cT3 disease was high (Table 2). As the 5‐year cancer‐specific survival rate for advanced UTUC patients is poor (<50% for pT2–3 patients, <10% for pT4 patients), neoadjuvant or adjuvant chemotherapy is considered for patients with NOC disease 5,16–19 . Neoadjuvant chemotherapy is beneficial to patients receiving cisplatin‐based chemotherapy, as it avoids loss of renal function after a nephroureterectomy.…”

Section: Discussionmentioning

confidence: 99%

Discrepancy between clinical and pathological T stages in upper urinary tract urothelial carcinoma: Analysis of the Hospital‐Based Cancer Registry data in Japan

et al. 2021

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Objective To examine the discrepancy between clinical and pathological T stages in patients with urothelial carcinoma of the upper urinary tract treated with radical surgery, and to compare them with the corresponding discrepancy in urothelial carcinoma of the bladder. Methods We used the Hospital‐Based Cancer Registry data in Japan to extract urothelial carcinoma of the bladder cases (n = 3747) and urothelial carcinoma of the upper urinary tract cases (n = 6831), including urothelial carcinoma of the renal pelvis (n = 3295) and urothelial carcinoma of the ureter (n = 3536) with cT1‐4N0M0 diagnosed in 2012–2015, histologically confirmed, and treated with radical surgery without chemotherapy or radiotherapy. We compared the T‐stage discrepancy among different tumor locations. Results The proportions of overall T‐stage discrepancy in the urothelial carcinoma of the renal pelvis (40.8%) and urothelial carcinoma of the ureter (42.9%) groups tended to be higher compared with that in the urothelial carcinoma of the bladder (38.8%) group. The upstaging rate from clinical non‐muscle‐invasive cancer (≤cT1) to pathological muscle‐invasive cancer (≥pT2) was significantly higher in the urothelial carcinoma of the renal pelvis and urothelial carcinoma of the ureter groups compared with the urothelial carcinoma of the bladder group (P = 0.002, P < 0.0001, respectively). Upstaging from clinical organ‐confined disease (≤cT2) to pathological non‐organ‐confined disease (≥pT3) was significantly more frequent in the urothelial carcinoma of the renal pelvis (27.8%, P < 0.0001) and urothelial carcinoma of the ureter (22.3%, P < 0.0001) groups compared with the urothelial carcinoma of the bladder (17.8%) group. Conclusion Discrepancy in T staging is significantly higher in patients with urothelial carcinoma of the upper urinary tract compared with those with urothelial carcinoma of the bladder, especially in those with organ‐confined disease. As T‐stage discrepancy might lead to missed opportunities to carry out perioperative treatment, more accurate diagnostic techniques are required to identify the appropriate urothelial carcinoma candidates for preoperative treatment.

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Section: Discussionmentioning

confidence: 99%

Discrepancy between clinical and pathological T stages in upper urinary tract urothelial carcinoma: Analysis of the Hospital‐Based Cancer Registry data in Japan

et al. 2021

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“…Based on the observations and results obtained through neoadjuvant chemotherapy in the treatment of bladder carcinoma, several retrospective studies have investigated the role of neoadjuvant therapy in UTUC. Utilizing preoperative cisplatin-based chemotherapy, pathological downstaging as well as lower recurrence rates and better outcomes have been observed (14,(89)(90)(91)(92). To date, no prospective trial has been published on this topic.…”

Section: Utuc In 2020mentioning

confidence: 99%

Characteristics of upper urinary tract urothelial carcinoma in the context of bladder cancer: a narrative review

Giudici¹,

Bonne²,

Blarer³

et al. 2021

Transl Androl Urol

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Urothelial carcinomas (UC) arise from the urothelium that covers the proximal urethra, urinary bladder, and the upper urinary tract. In daily routine and clinical trials UC originating from different locations are often treated and investigated in the same manner. However, differences between the two locations seem to be apparent and may question in handling them as a single oncologic entity. In this review we discuss similarities and differences between bladder and upper urinary tract UC and consider their potential impact on treatment strategies. Despite similarities of UC in the bladder (BC) and the upper urinary tract (UTUC), clinicopathologic and molecular differences may question to generally assemble both as a single tumor entity. Treatment standards for UTUC are often adopted from BC. However, a specific investigation in the former may still be meaningful as shown by the example of adjuvant cisplatin based chemotherapy. In conclusion, future investigations should prioritize the understanding of the tumor biology of both BC and UTUC. This may reveal which UTUC can be treated according to treatment standards of BC and in which cases, a separate approach may be more appropriate.

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“…Heterogeneity existed among studies based on Cochran Q statistics (P=0.036) and I 2 =34.7%. In addition, pPR rate was displayed in 10 studies (13,(19)(20)(21)23,25,28,29,31,32). After analyzing data from the 10 studies, the pooled pPR rate was 40% (95% CI: 0.32-0.49; P<0.001), which revealed that about 4 in ten patients with UTUC treated with NAC can achieve pPR (Figure 3B).…”

Section: Dfsmentioning

confidence: 99%

“…Characteristics and details of included studies CSS, cancer-specific survival; PFS, progression-free survival; DFS, disease-free survival; pCR, pathological complete response pPR, pathological partial response. NA, not available GCarbo , gemcitabine and carboplatin; MVAC, methotrexate; vinblastine; doxorubicin; and cisplatin; GC, gemcitabine and cisplatin; MEP, methotrexate, etoposide, and cisplatin; MEC, methotrexate, etoposide and etoposide; MVEC, methotrexate, vinblastine, etoposide and cisplatin; GCI, gemcitabine and cisplatin, and ifosfamide; d-MVDC, dose dense methotrexate, vinblastine, doxorubicin and cisplatin.OSIn total, 9 included studies reported the OS results(14,(18)(19)(20)(21)(22)(23)(24)(25). After pooling the data across the 9 studies, we obtained the results were HR 2.14 (95% CI: 1.75-2.63; P<0.001), which represented a 2.14 times OS benefit in UTUC patients undergoing NAC following surgery compared to surgery alone (Figure2A).…”

mentioning

confidence: 93%

Effect of neoadjuvant chemotherapy on locally advanced upper tract urothelial carcinoma: a pooled analysis

Qiu

et al. 2020

Transl Androl Urol

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Background: The outcome of neoadjuvant chemotherapy (NAC) has been established in bladder cancer but remains controversial in upper tract urothelial carcinoma (UTUC). In this work, we explored the therapeutic effect of NAC in patients with locally advanced UTUC. Methods:We conducted a literature search on articles published from 1995 up to April 2020 in PubMed/ Medline, the Cochrane Library, Embase, Google Scholar. A total of 19 eligible studies with 6,283 patients were identified, from which the overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), disease-free survival (DFS), pathological complete response (pCR) rate and pathological partial response (pPR) rate were extracted. All analyses were conducted using Review Manager 5.3 and Stata statistical software (version 15).Results: In total, 6,283 UTUC patients were included from 19 eligible studies out of which 1,474 patients received NAC and subsequent radical nephroureterectomy (RNU), whereas 4,809 patients received RNU only. Compared with single RNU, patients with NAC and subsequent RNU exhibited longer OS, CSS,

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High Response Rates to Neoadjuvant Chemotherapy in High-Grade Upper Tract Urothelial Carcinoma

Cited by 30 publications

References 23 publications

Discrepancy between clinical and pathological T stages in upper urinary tract urothelial carcinoma: Analysis of the Hospital‐Based Cancer Registry data in Japan

Discrepancy between clinical and pathological T stages in upper urinary tract urothelial carcinoma: Analysis of the Hospital‐Based Cancer Registry data in Japan

Characteristics of upper urinary tract urothelial carcinoma in the context of bladder cancer: a narrative review

Effect of neoadjuvant chemotherapy on locally advanced upper tract urothelial carcinoma: a pooled analysis

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