Analysis of Neoadjuvant Chemotherapy Utilization, Pathologic Response, and Overall Survival in Upper Tract Urothelial Carcinoma

IF 2.3 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer Pub Date : 2024-09-17 DOI:10.1016/j.clgc.2024.102224

Vincent E. Xu , Oluwafolajimi Adesanya , Sarah Azari , Samita Islam , Matthew Klein , Arthur Drouaud , Ryan M. Antar , Phat Chang , Armine Smith , Michael J Whalen

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Abstract

Introduction

Upper tract urothelial carcinoma (UTUC) is a rare malignancy with poor prognosis. Radical nephroureterectomy (RNU) remains the standard treatment for high-risk UTUC. Considering the decline in renal function with RNU and results from prospective trials, NAC has emerged as a favored perioperative treatment for chemo-eligible patients with UTUC. However, strong evidence of the efficacy of NAC and predictors for its use are scarce. We aimed to assess trends in NAC utilization and pathologic outcomes and survival with NAC use.

Methods

The National Cancer Database was queried for patients with high-grade cTanyNanyM0 UTUC treated with RNU from 2004 to 2019. Outcomes included overall survival (OS), pathologic response (pR) and pathologic complete response (pCR), defined as ≤pT1pN0/X and pT0pN0/X, respectively.

Results

Of 6,645 patients treated with RNU, 209 received RNU NAC. Greater distance from treatment facility decreased the likelihood of receiving NAC. Higher cT stages (OR 1.72, P = .028), cN+ status (OR 7.40, P < .001) and treatment at an academic facility (OR 2.02, P < .001) predicted NAC treatment. NAC was associated with 34.0% pR and 5.3% pCR. In multivariable analysis, patients with pR and pCR had improved OS (HR = 0.176, P < .014).

Conclusion

We report significant response rates with NAC and improved OS in patients who experienced pR or pCR. Over a 15-year study period, NAC was underutilized, especially in nonacademic settings and among patients living farther from care facilities, underscoring the need for improved regionalization and multidisciplinary approaches in UTUC management.

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上尿路上皮癌的新辅助化疗使用、病理反应和总生存率分析

导言上尿路上皮癌（UTUC）是一种罕见的恶性肿瘤，预后较差。根治性肾切除术（RNU）仍是高危UTUC的标准治疗方法。考虑到 RNU 会导致肾功能下降以及前瞻性试验的结果，NAC 已成为符合化疗条件的 UTUC 患者首选的围手术期治疗方法。然而，有关 NAC 疗效的有力证据以及使用 NAC 的预测因素却很少。我们旨在评估NAC的使用趋势以及使用NAC后的病理结果和生存率。方法查询了2004年至2019年接受RNU治疗的高级别cTanyNanyM0 UTUC患者的国家癌症数据库。结果在接受RNU治疗的6645名患者中，有209人接受了RNU NAC治疗。与治疗机构的距离越远，接受 NAC 的可能性越小。较高的 cT 分期（OR 1.72，P = .028）、cN+ 状态（OR 7.40，P < .001）和在学术机构接受治疗（OR 2.02，P < .001）预示着 NAC 治疗。NAC与34.0%的pR和5.3%的pCR相关。在多变量分析中，pR 和 pCR 患者的 OS 有所改善（HR = 0.176，P < .014）。在长达15年的研究期间，NAC的使用率较低，尤其是在非学术环境和远离医疗机构的患者中，这说明在UTUC管理中需要改进区域化和多学科方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical genitourinary cancer 医学-泌尿学与肾脏学

CiteScore

5.20

自引率

6.20%

发文量

201

审稿时长

54 days

期刊介绍： Clinical Genitourinary Cancer is a peer-reviewed journal that publishes original articles describing various aspects of clinical and translational research in genitourinary cancers. Clinical Genitourinary Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of genitourinary cancers. The main emphasis is on recent scientific developments in all areas related to genitourinary malignancies. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.