Trends in the use of neoadjuvant chemotherapy and oncological outcomes for high‐risk upper tract urothelial carcinoma: a multicentre retrospective study

Abstract

To evaluate temporal trends in neoadjuvant chemotherapy (NAC) utilisation and outcomes in patients with locally advanced upper tract urothelial carcinoma (UTUC). Patients and MethodsWe included 289 patients from seven hospitals who underwent radical nephroureterectomy (RNU) for locally advanced UTUC (≥cT3 or cN+) between 2000 and 2020. These patients received RNU alone or two to four courses of NAC with either a cisplatin-or carboplatin-based regimen. We evaluated the temporal changes in NAC use and compared the visceral recurrence-free, cancer-specific, and overall survival rates. The effect of NAC on oncological outcomes was examined using multivariate Cox regression analysis with inverse probability of treatment weighting (IPTW) models. ResultsOf 289 patients, 144 underwent NAC followed by RNU (NAC group) and 145 underwent RNU alone (Control [Ctrl] group). NAC use increased significantly from 19% (2006-2010), 58% (2011)(2012)(2013)(2014)(2015), to 79% (2016-2020). Pathological downstaging was significantly higher in the NAC group than in the Ctrl group. The IPTW-adjusted multivariable analyses showed that NAC significantly improved the oncological outcomes in the NAC group compared with the Ctrl group. Moreover, carboplatin-based NAC significantly improved the oncological outcomes in the NAC group compared with the Ctrl group among patients with chronic kidney disease Stage ≥3. There were no significant differences in oncological outcomes between the cisplatin-and carboplatin-based regimens. ConclusionsThe use of NAC for high-risk UTUC increased significantly after 2010. Platinum-based short-term NAC followed by immediate RNU may not impede and potentially improves oncological outcomes.

Prognostic impact of eligibility for adjuvant immunotherapy in locally advanced urothelial cancer

“…Of the inclusion criteria of those phase III studies, the patient's lymphovascular invasion (LVI) status was not included in the definition of high-risk disease. Because LVI status is one of the established pathological risk factors for poor prognosis in patients with UC, [13][14][15][16][17][18][19] we hypothesize that it might play a key role in the selection of potential candidates for adjuvant immunotherapy.…”

“…Of the inclusion criteria of those phase III studies, the patient's lymphovascular invasion (LVI) status was not included in the definition of high‐risk disease. Because LVI status is one of the established pathological risk factors for poor prognosis in patients with UC, 13 , 14 , 15 , 16 , 17 , 18 , 19 we hypothesize that it might play a key role in the selection of potential candidates for adjuvant immunotherapy. Firstly, we evaluate the effect of trial eligibility for adjuvant immunotherapy on prognosis in patients with localized and locally advanced muscle‐invasive bladder carcinoma (MIBC) and upper tract urothelial carcinoma (UTUC) in a real‐world practice.…”

Contemporary Trends of Systemic Neoadjuvant and Adjuvant Intravesical Chemotherapy in Patients With Upper Tract Urothelial Carcinomas Undergoing Minimally Invasive or Open Radical Nephroureterectomy: Analysis of US Claims on Perioperative Outcomes and Health Care Costs

“…This very low number is discordant as to what is being recently reported from other experiences in other countries. Japanese data from Hamaya et al [21], reported a significantly increased use of NAC for high-risk UTUC after 2010 from a baseline of 19% (2006)(2007)(2008)(2009)(2010), to 58% from 2011-2015, and to 79% from 2016-2020. Also, we were able to model NAC influence in relation to perioperative outcomes which in the future should be evaluated in the patient-and tumor-related decision-making process.…”

The Effect of Upfront Intensive Therapy on Primary Resistance in Metastatic Castration-sensitive Prostate Cancer: A Multicenter Retrospective Study

“…Multivariable Cox regression analysis was conducted to investigate the effect of upfront intensive therapy after adjusting for potential confounders using a propensity score-based inverse probability of treatment weighting (IPTW) method to adjust for group imbalances in the oncological outcomes. 29,30 HRs with 95% CIs were calculated after controlling for potential confounders for upfront therapy, including patient age, ECOG PS, Gleason score, EOD. P values < 0.05 were considered statistically signi cant.…”