Mp38-12 a National Analysis Comparing Treatment Modalities in Patients With High-Risk Upper Tract Urothelial Cancer

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP38)1 May 2024MP38-12 A NATIONAL ANALYSIS COMPARING TREATMENT MODALITIES IN PATIENTS WITH HIGH-RISK UPPER TRACT UROTHELIAL CANCER Saad Sabbagh, Mohamed Mohanna, Hong Liang, Nicolas Muruve, Barbara Ercole, Alok Shrivastava, Fernando Cabrera, Christopher Weight, George P. Haber, Rafael Arteta-Bulos, and Alberto Pieretti Saad SabbaghSaad Sabbagh , Mohamed MohannaMohamed Mohanna , Hong LiangHong Liang , Nicolas MuruveNicolas Muruve , Barbara ErcoleBarbara Ercole , Alok ShrivastavaAlok Shrivastava , Fernando CabreraFernando Cabrera , Christopher WeightChristopher Weight , George P. HaberGeorge P. Haber , Rafael Arteta-BulosRafael Arteta-Bulos , and Alberto PierettiAlberto Pieretti View All Author Informationhttps://doi.org/10.1097/01.JU.0001008700.92603.b1.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The optimal timing of perioperative chemotherapy for upper tract urothelial (UTUC) patients remains controversial. Neoadjuvant Chemotherapy (NAC) offers the advantage of administering cisplatin-based chemotherapy when patients have maximal renal function, but it carries the risk of overtreatment due to potential clinical staging inaccuracies. Conversely, despite the survival benefit of adjuvant chemotherapy (AC), patients with a postoperative decline in renal function may not be eligible for AC. Our study conducted an overall survival (OS) analysis between nephroureterectomy (NU), NAC+NU, and NU+AC in patients with high-risk UTUC. METHODS: The National Cancer Database (NCDB) was utilized to identify patients diagnosed with UTUC between 2004 and 2020. Patients included were diagnosed with cT2-T4N0M0. Patients with unknown data on the type of surgery, chemotherapy, and survival outcomes were excluded. Patients who received radiation therapy, single-agent chemotherapy, or surgery other than NU were excluded. Patients were classified into three groups: NU alone, NAC+NU, and NU+AC. Based on the clinical covariates, the propensity score (PS) matched sample was constructed with a greedy nearest neighbor using a caliper of width equal to 0.2 of the standard deviation (SD). The Cox proportional hazards model with robust variance estimators and a Kaplan-Meier curve compared OS between the PS-paired samples. RESULTS: We identified 3,501 patients with UTUC who met the inclusion criteria. The most common treatment modality was NU alone (77.8%), followed by the NU+AC group (16%). Additionally, most patients had a Charlson-Deyo comorbidity score of 0 (66.12%), a high-grade tumor (51.4%), and a clinical T3 stage (56.3%). In our PS-matched samples, NU alone had a worse OS compared to NAC+NU and NU+AC (HR 1.47, p 0.028, 95%CI 1.04-2.08 and HR 1.31, p 0.0007, 95%CI 1.12-1.52, respectively). Among the two groups who had PC, there was no statistically significant difference in OS (Figure 1). CONCLUSIONS: This nationwide study confirms that perioperative chemotherapy improves OS in patients with high-risk UTUC, with no difference in OS between NAC+NU and NU+AC. Further prospective data is warranted to identify the ideal patient population that might benefit from each treatment modality to minimize overtreatment from NAC. Download PPT Source of Funding: This work was supported by the Maroone Cancer Center, Cleveland Clinic Florida. No external funding is reported © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e645 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Saad Sabbagh More articles by this author Mohamed Mohanna More articles by this author Hong Liang More articles by this author Nicolas Muruve More articles by this author Barbara Ercole More articles by this author Alok Shrivastava More articles by this author Fernando Cabrera More articles by this author Christopher Weight More articles by this author George P. Haber More articles by this author Rafael Arteta-Bulos More articles by this author Alberto Pieretti More articles by this author Expand All Advertisement PDF downloadLoading ...