Pd20-12 Neoadjuvant Therapy in Initially Inoperable Upper Tract Urothelial Carcinoma—a Comparative Study With Adjuvant Strategies

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD20)1 May 2024PD20-12 NEOADJUVANT THERAPY IN INITIALLY INOPERABLE UPPER TRACT UROTHELIAL CARCINOMA—A COMPARATIVE STUDY WITH ADJUVANT STRATEGIES Yu-Kai Huang, Eric Yi-Hsiu Huang, Alex Teng-Lung Lin, Yen-Hwa Chang, Hsiao-Jen Chung, Tzu-Ping Lin, Chih-Chieh Lin, Wei-Jen Chen, Ming-Hsuan Ku, William J. S. Huang, Chueh-Chuan Yen, Peter Mu-Hsin Chang, and Jiun-I Lai Yu-Kai HuangYu-Kai Huang , Eric Yi-Hsiu HuangEric Yi-Hsiu Huang , Alex Teng-Lung LinAlex Teng-Lung Lin , Yen-Hwa ChangYen-Hwa Chang , Hsiao-Jen ChungHsiao-Jen Chung , Tzu-Ping LinTzu-Ping Lin , Chih-Chieh LinChih-Chieh Lin , Wei-Jen ChenWei-Jen Chen , Ming-Hsuan KuMing-Hsuan Ku , William J. S. HuangWilliam J. S. Huang , Chueh-Chuan YenChueh-Chuan Yen , Peter Mu-Hsin ChangPeter Mu-Hsin Chang , and Jiun-I LaiJiun-I Lai View All Author Informationhttps://doi.org/10.1097/01.JU.0001009556.54476.eb.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Upper tract urothelial carcinoma (UTUC) presents a clinical challenge due to its heightened aggressiveness. While surgical intervention is the standard treatment for localized disease, the role of neoadjuvant therapy in managing locally advanced UTUC remains less explored. METHODS: Between 2010 and 2021, we conducted 70 patients with locally advanced UTUC. 25 patients were initially deemed inoperable due to the local aggressiveness. They underwent neoadjuvant therapies, which included gemcitabine-cisplatin (GC) (60.0%, 15/25), gemcitabine-carboplatin (GCa) (12.0%, 3/25), and other regimens (28.0%, 7/25). Radical nephroureterectomy and bladder cuff excision (RNU BCE) was possible after neoadjuvant therapies, forming the neoadjuvant group. Another 45 patients underwent RNU BCE as their initial treatment, followed by adjuvant therapy with either GC or GCa regimen, forming the adjuvant group. We collected data on follow-up duration, mortality, progression time, pathologic complete response (pCR) defined as ypT0N0M0, and pathologic downstaging while the clinical AJCC stage was higher than the pathologic AJCC stage. Overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) were compared between the neoadjuvant group and the adjuvant group using a Cox regression model. RESULTS: Among the 70 patients, a mean age was 71.20 years (range 50-87 years). The median follow-up time was 30.5 months. Notably, ypT0N0M0 was achieved in 4 patients (16.0%), and 15 patients (60.0%) experienced pathologic downstaging in the neoadjuvant group. Cox regression analysis showed no significant difference in OS (HR=1.024, 95% CI: 0.45-2.31, p=0.955), CSS (HR=0.985, 95% CI: 0.41-2.35, p=0.972), and PFS (HR=0.91, 95% CI: 0.45-1.83, p=0.79) between the two groups. Within the neoadjuvant subgroup, those who received either GC or GCa regimen were further analyzed (18 patients), analysis showed no significant difference in OS (HR=1.28, 95% CI: 0.51-3.20, p=0.597), CSS (HR=1.13, 95% CI: 0.42-3.06, p=0.809), and PFS (HR=0.771, 95% CI: 0.34-1.77, p=0.54) between the two groups. CONCLUSIONS: For those who initially presented with locally advanced inoperable UTUC, neoadjuvant therapy has shown the potential to render these patients amenable to surgical intervention in our experience. We also observed complete pathologic responses in a substantial proportion of patients. Moreover, comparable survival outcomes, including OS, CSS, and PFS were noted when compared to those who underwent adjuvant therapy following surgery. Source of Funding: No funding © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e451 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Yu-Kai Huang More articles by this author Eric Yi-Hsiu Huang More articles by this author Alex Teng-Lung Lin More articles by this author Yen-Hwa Chang More articles by this author Hsiao-Jen Chung More articles by this author Tzu-Ping Lin More articles by this author Chih-Chieh Lin More articles by this author Wei-Jen Chen More articles by this author Ming-Hsuan Ku More articles by this author William J. S. Huang More articles by this author Chueh-Chuan Yen More articles by this author Peter Mu-Hsin Chang More articles by this author Jiun-I Lai More articles by this author Expand All Advertisement PDF downloadLoading ...