Lower pathological stage seen in neoadjuvant chemo-treated patients with urothelial carcinoma
Pathological stage distribution is lower in patients with high-risk upper tract urothelial carcinoma treated with neoadjuvant chemotherapy than in those treated with radical nephroureterectomy alone, reports a study.
The authors retrospectively analysed the records of 240 patients with upper tract urothelial carcinoma at The John Hopkins Hospital from 2003 to 2017 to evaluate differences in their pathological stage distribution.
Neoadjuvant chemotherapy was offered prior to radical nephroureterectomy to patients with biopsy-proven high-grade disease and a visible lesion on cross-sectional imaging (study group). A control group consisting of a time-matched cohort of patients with biopsy-proven high-grade disease underwent extirpative surgery alone. The authors assessed clinical and pathological variables between the cohorts via chi-square and Fisher exact tests.
Thirty-two patients in the study group and 208 in the control group were included in the analysis. The study group demonstrated significantly lower pathological stage compared with the control group (p<0.001).
There were significantly fewer patients with pT2 disease or higher treated with neoadjuvant chemotherapy (37.5 percent vs 59.6 percent; p=0.02). A 46.5-percent reduction was noted in the prevalence of pT3 disease or higher among patients without clinically node positive or low volume metastatic disease in the study group (25.9 percent vs 48.4 percent; p=0.04).
In addition, a 9.4-percent complete remission rate was observed in patients who underwent neoadjuvant chemotherapy.
“High-risk upper tract urothelial carcinoma has been associated with poor survival outcomes,” the authors said. “Limited retrospective data support neoadjuvant chemotherapy prior to radical nephroureterectomy.”