INTRODUCTION AND OBJECTIVE: Preliminary results of phase II trials support the effectiveness of neoadjuvant (Nad) chemotherapy (CHT) for high-grade upper tract urothelial carcinoma (UTUC), although available data are still immature. In this study we assessed the role of perioperative CHT in a large multicenter cohort of patients with UTUC, treated with nephroureterectomy (NUT). METHODS: A multicenter retrospective analysis utilizing the ROBUUST (ROBotic surgery for Upper tract urothelial cancer STudy) registry was performed. Baseline, preoperative, perioperative, and pathologic variables of three groups of patients receiving NUT only, Nad-CHT or Adjuvant (Ad) CHT were compared. Categorical and continuous variables among the three subgroups were compared with Chi square and ANOVA tests, respectively. Stage-specific (cT 0-2, cT≥3 and cN+) Kaplan-Meier analysis were performed to compare Cancer-specific survival (CSS) probabilities. RESULTS: Overall, 1994 patients were included. Nad-CHT patients displayed a significantly higher rate of cT stage≥3 (p<0.001) and cN positive stage (p<0.001). Overall complications and Clavien grade≥3 complications rates were comparable among the three subgroups (p=0.65 and p=0.92, respectively). At Kaplan-Meier analysis specific for cT0-2 patients, no significant differences were detected among the three groups of patients (24-mo: Nad-CHT 89.2%, NUT 91.5%, Ad-CHT 88.8%; p=0.34). On the other hand, at Kaplan-Meier curve specific for cT≥3 stage, Nad-CHT showed a significantly higher rate of CSS than the other two cohorts (24-mo: Nad-CHT 81.1%, NUT 66.9%, Ad-CHT 69.9%; p=0.03). Accordingly, at Kaplan-Meier analysis specific for cN positive patients, Nad-CHT showed a significantly higher rate of CSS than the other two cohorts (24-mo: Nad-CHT 75.6%, NUT 63.6%, Ad-CHT 59.4%, p=0.03). CONCLUSIONS: Our retrospective analysis of a large multicenter dataset suggests that, in specific scenarios, such as locally advanced and clinically positive nodes disease, NadCHT seems to offer a significant benefit in terms of CSS, with a negligible impact on surgical morbidity. Further data from randomised controlled trials are expected.
REAL-WORLD DATA: CALL FOR PARADIGM SHIFT TOWARDS NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA TREATED WITH NEPHROURETERECTOMY-ANALYSIS OF THE ROBUUST REGISTRY / Tuderti, Gabriele; Proietti, Flavia; Wu, Zhenjie; Franco, Antonio; Wang, Linhui; Margulis, Vitaly; Bhanvadia, Raj; Abdollah, Firas; Finati, Marco; Antonelli, Alessandro; Ditonno, Francesco; Singla, Nirmish; Broenimann, Stephan; Derweesh, Ithaar H.; Puri, Dhruv; Rais-Bahrami, Soroush; Moon, Sol C.; Ferro, Matteo; Tozzi, Marco; Porpiglia, Francesco; Checcucci, Enrico; Correa, Andreas; Helstrom, Emma; Gonzalgo, Mark L.; Mendiola, Dinno F.; Perdona, Sisto; Tufano, Antonio; Eilender, Benjamine M.; Mehrazin, Reza; Yong, Courtney; Sundaram, Chandru P.; Ghoreifi, Alireza; Djaladat, Hooman; Autorino, Riccardo; Simone, Giuseppe. - In: THE JOURNAL OF UROLOGY. - ISSN 0022-5347. - (2024).
REAL-WORLD DATA: CALL FOR PARADIGM SHIFT TOWARDS NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA TREATED WITH NEPHROURETERECTOMY-ANALYSIS OF THE ROBUUST REGISTRY
Tuderti, Gabriele;Proietti, Flavia;Franco, Antonio;Antonelli, Alessandro;Ditonno, Francesco;Ferro, Matteo;Tozzi, Marco;Tufano, Antonio;
2024
Abstract
INTRODUCTION AND OBJECTIVE: Preliminary results of phase II trials support the effectiveness of neoadjuvant (Nad) chemotherapy (CHT) for high-grade upper tract urothelial carcinoma (UTUC), although available data are still immature. In this study we assessed the role of perioperative CHT in a large multicenter cohort of patients with UTUC, treated with nephroureterectomy (NUT). METHODS: A multicenter retrospective analysis utilizing the ROBUUST (ROBotic surgery for Upper tract urothelial cancer STudy) registry was performed. Baseline, preoperative, perioperative, and pathologic variables of three groups of patients receiving NUT only, Nad-CHT or Adjuvant (Ad) CHT were compared. Categorical and continuous variables among the three subgroups were compared with Chi square and ANOVA tests, respectively. Stage-specific (cT 0-2, cT≥3 and cN+) Kaplan-Meier analysis were performed to compare Cancer-specific survival (CSS) probabilities. RESULTS: Overall, 1994 patients were included. Nad-CHT patients displayed a significantly higher rate of cT stage≥3 (p<0.001) and cN positive stage (p<0.001). Overall complications and Clavien grade≥3 complications rates were comparable among the three subgroups (p=0.65 and p=0.92, respectively). At Kaplan-Meier analysis specific for cT0-2 patients, no significant differences were detected among the three groups of patients (24-mo: Nad-CHT 89.2%, NUT 91.5%, Ad-CHT 88.8%; p=0.34). On the other hand, at Kaplan-Meier curve specific for cT≥3 stage, Nad-CHT showed a significantly higher rate of CSS than the other two cohorts (24-mo: Nad-CHT 81.1%, NUT 66.9%, Ad-CHT 69.9%; p=0.03). Accordingly, at Kaplan-Meier analysis specific for cN positive patients, Nad-CHT showed a significantly higher rate of CSS than the other two cohorts (24-mo: Nad-CHT 75.6%, NUT 63.6%, Ad-CHT 59.4%, p=0.03). CONCLUSIONS: Our retrospective analysis of a large multicenter dataset suggests that, in specific scenarios, such as locally advanced and clinically positive nodes disease, NadCHT seems to offer a significant benefit in terms of CSS, with a negligible impact on surgical morbidity. Further data from randomised controlled trials are expected.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
