Mp38-19 Real-World Outcomes of Adjuvant Immunotherapy Candidates With Upper Tract Urothelial Carcinoma: Results of a Multicenter Cohort Study

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP38)1 May 2024MP38-19 REAL-WORLD OUTCOMES OF ADJUVANT IMMUNOTHERAPY CANDIDATES WITH UPPER TRACT UROTHELIAL CARCINOMA: RESULTS OF A MULTICENTER COHORT STUDY Hirokazu Kagawa, Fumihiko Urabe, Kosuke Iwatani, Yu Imai, Kojiro Tashiro, Shunsuke Tsuzuki, Akira Furuta, and Takahiro Kimura Hirokazu KagawaHirokazu Kagawa , Fumihiko UrabeFumihiko Urabe , Kosuke IwataniKosuke Iwatani , Yu ImaiYu Imai , Kojiro TashiroKojiro Tashiro , Shunsuke TsuzukiShunsuke Tsuzuki , Akira FurutaAkira Furuta , and Takahiro KimuraTakahiro Kimura View All Author Informationhttps://doi.org/10.1097/01.JU.0001008700.92603.b1.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recent clinical trial (CheckMate 274 trial) has reported improved disease-free survival rates of patients with stage pT3–4/ypT2–4 or (y)pN+ upper tract urothelial carcinoma (UTUC) on adjuvant nivolumab therapy. However, the appropriateness of the patient selection criteria used in clinical practice remains uncertain. METHODS: We retrospectively analyzed 895 patients who underwent nephroureterectomy to treat UTUC. The patients were divided into two groups: grade pT3–4 and/or pN+ without neoadjuvant chemotherapy (NAC) or grade ypT2–4 and/or ypN+ on NAC (adjuvant immunotherapy candidates) and others (not candidates for adjuvant immunotherapy). Kaplan-Meier curves were drawn to assess the oncological outcomes, i.e., recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Cox proportional hazards models were used to identify significant prognostic factors for oncological outcomes. RESULTS: In total, 44.8% of patients were candidates for adjuvant immunotherapy. During follow-up, 232 (25.9%) patients developed metastases; there were 145 (16.2%) cases of cancer-specific mortality and 189 (21.1%) patients died of any cause. The 3-year RFS, CSS, and OS rates were 72.2%, 83.1%, and 79.0%, respectively. The Kaplan-Meier curves revealed significantly inferior RFS, CSS, and OS among candidates for adjuvant immunotherapy (p<0.01, p<0.01, and p<0.01, respectively) (Figure 1a–c). In contrast, the RFS, CSS, and OS did not differ significantly between candidates for adjuvant immunotherapy on NAC and not on NAC (p=0.75, p=0.67, and p=0.93, respectively) (Figure 1a–c). Similar trends were observed in those who were not candidates for adjuvant immunotherapy (p=0.90, p=0.46, and p=0.69, respectively) (Figure 1a–c). Multivariate analysis revealed that pathological T (pT3–4 or ypT2–4) and N (pN+ or ypN+) and lymphovascular invasion (LVI) status were independent risk factors for poor RFS, CSS, and OS. CONCLUSIONS: The adjuvant immunotherapy candidate criteria can be used to stratify UTUC patients post-nephroureterectomy. In addition to pathological T and N status, LVI was a significant predictor of survival, and may thus play a pivotal role in the selection of patients eligible for adjuvant immunotherapy. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e649 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Hirokazu Kagawa More articles by this author Fumihiko Urabe More articles by this author Kosuke Iwatani More articles by this author Yu Imai More articles by this author Kojiro Tashiro More articles by this author Shunsuke Tsuzuki More articles by this author Akira Furuta More articles by this author Takahiro Kimura More articles by this author Expand All Advertisement PDF downloadLoading ...