Pd20-08 Response to Neoadjuvant Chemotherapy Is Associated With Improved Survival in Upper Tract Urothelial Carcinoma—an Upper Tract Collaborative Network (Ucan) Study

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD20)1 May 2024PD20-08 RESPONSE TO NEOADJUVANT CHEMOTHERAPY IS ASSOCIATED WITH IMPROVED SURVIVAL IN UPPER TRACT UROTHELIAL CARCINOMA—AN UPPER TRACT COLLABORATIVE NETWORK (UCAN) STUDY Alice Yu, Patrick J. Hensley, Heather L. Huelster, Austin Martin, Jonathan Pham, Maximilian Pallauf, Andrew Katims, Aaron Potrezke, Jay D. Raman, Nirmish Singla, Vitaly Margulis, Jonathan Coleman, Surena F. Matin, and Philippe E. Spiess Alice YuAlice Yu , Patrick J. HensleyPatrick J. Hensley , Heather L. HuelsterHeather L. Huelster , Austin MartinAustin Martin , Jonathan PhamJonathan Pham , Maximilian PallaufMaximilian Pallauf , Andrew KatimsAndrew Katims , Aaron PotrezkeAaron Potrezke , Jay D. RamanJay D. Raman , Nirmish SinglaNirmish Singla , Vitaly MargulisVitaly Margulis , Jonathan ColemanJonathan Coleman , Surena F. MatinSurena F. Matin , and Philippe E. SpiessPhilippe E. Spiess View All Author Informationhttps://doi.org/10.1097/01.JU.0001009556.54476.eb.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Neoadjuvant chemotherapy (NAC) is recommended for high-risk upper tract urothelial carcinoma (UTUC) based on positive results from prospective clinical trials establishing efficacy from pathologic response and preliminary evidence of clinical benefit. Unfortunately, clinical trials in this disease to date have been limited by small sample sizes owing to the rarity of the disease. To address the hypothesis that NAC can improve outcomes for UTUC patients, we sought to evaluate the association between NAC treatment response and survival in UTUC patients using a large, well-curated multi-institutional database. METHODS: Analysis was conducted by the UTUC Collaborative Network (UCAN), that combines data from 2276 UTUC patients who underwent radical nephroureterectomy (RNU) at 7 high-volume tertiary care centers in the United States. NAC was defined as any chemotherapy given prior to surgery for UTUC. Patients with ypT0-T1 N0 on final surgical pathology were defined as "responders" and patients with ³ ypT2 or ³N1 were "non-responders". Progression was defined as recurrence in either lymph nodes, retroperitoneal soft tissue or distant metastasis. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Cox regression was used to control for baseline characteristics. RESULTS: 378 patients underwent NAC, and on final surgical pathology, 101 (26.8%) cases were £ypT1N0. Among patients who received NAC, responders had significantly improved OS (Figure 1) and PFS. At 5 years from surgery, 81.4% of responders were alive compared to 59.8% of non-responders. Median OS among non-responders was 85.2 months (95% CI 68.0 – 117.7), while median OS was not reached among responders. Median PFS among non-responders was 73.0 months (95% CI 54.3 – 112.6), and median PFS was not reached among responders. Even after controlling for baseline patient characteristics, responders had a significant survival benefit Hazard ratio (HR) 0.37, 95% CI 0.23 – 0.61, p<0.001. CONCLUSIONS: Responders to NAC exhibit significantly improved survival, further underscoring the benefits of NAC in well-selected patients. This data has clinical utility for patient counseling, prognostic assessment and determining necessity for adjuvant therapy. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e449 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alice Yu More articles by this author Patrick J. Hensley More articles by this author Heather L. Huelster More articles by this author Austin Martin More articles by this author Jonathan Pham More articles by this author Maximilian Pallauf More articles by this author Andrew Katims More articles by this author Aaron Potrezke More articles by this author Jay D. Raman More articles by this author Nirmish Singla More articles by this author Vitaly Margulis More articles by this author Jonathan Coleman More articles by this author Surena F. Matin More articles by this author Philippe E. Spiess More articles by this author Expand All Advertisement PDF downloadLoading ...