Nima Almassi1, Tianming Gao2, Byron Lee3, Robert J Stein3, Georges-Pascal Haber3, Moshe C Ornstein4, Brian I Rini4, Timothy D Gilligan4, Jorge A Garcia4, Andrew J Stephenson3, Petros Grivas5. 1. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH. 2. Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH. 3. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH. 4. Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH. 5. Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH; University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA (current). Electronic address: pgrivas@uw.edu.
Abstract
BACKGROUND: Neoadjuvant chemotherapy (NAC) has been increasingly adopted in the management of high-grade upper tract urothelial carcinoma (UTUC), largely extrapolating from level I evidence in urothelial carcinoma of the bladder. Studies examining pathologic outcomes in patients with UTUC receiving NAC are mostly limited to retrospective, single-center studies with limited sample size, with results of a phase II trial recently presented. Hypothesizing that NAC is associated with improved pathologic response (PR), we compared pathologic outcomes in patients with high-grade UTUC who did and did not receive NAC before extirpative surgery. PATIENTS AND METHODS: A total of 6174 patients with nonmetastatic, high-grade UTUC who underwent extirpative surgery from 2006 to 2014 were identified from the National Cancer Database. Patients were stratified by NAC status. PR was defined as pathologic stage less than clinical stage. Univariate and multivariable logistic regression analysis was employed to identify predictors of PR. RESULTS: Two hundred sixty (4.2%) patients received NAC. A higher incidence of PR was observed in patients receiving NAC (25.2% vs. 1.8%; P < .001), with complete PR observed in 6.1% of patients receiving NAC and 0.4% of patients undergoing surgery alone. NAC (odds ratio [OR], 19.8; 95% confidence interval [CI], 11.8-33.5), nonwhite race (OR, 3.2; 95% CI, 1.7-6.3), and ureteral tumor location (OR, 1.6; 95% CI, 1.02-2.6) were independently associated with PR. CONCLUSIONS: Examining a large national cancer registry, we observed a higher incidence of PR in patients with UTUC receiving NAC, validating findings of prior studies. Our findings support consideration of NAC in high grade UTUC. Prospective trials will better define the impact of NAC on pathologic and survival outcomes.
BACKGROUND: Neoadjuvant chemotherapy (NAC) has been increasingly adopted in the management of high-grade upper tract urothelial carcinoma (UTUC), largely extrapolating from level I evidence in urothelial carcinoma of the bladder. Studies examining pathologic outcomes in patients with UTUC receiving NAC are mostly limited to retrospective, single-center studies with limited sample size, with results of a phase II trial recently presented. Hypothesizing that NAC is associated with improved pathologic response (PR), we compared pathologic outcomes in patients with high-grade UTUC who did and did not receive NAC before extirpative surgery. PATIENTS AND METHODS: A total of 6174 patients with nonmetastatic, high-grade UTUC who underwent extirpative surgery from 2006 to 2014 were identified from the National Cancer Database. Patients were stratified by NAC status. PR was defined as pathologic stage less than clinical stage. Univariate and multivariable logistic regression analysis was employed to identify predictors of PR. RESULTS: Two hundred sixty (4.2%) patients received NAC. A higher incidence of PR was observed in patients receiving NAC (25.2% vs. 1.8%; P < .001), with complete PR observed in 6.1% of patients receiving NAC and 0.4% of patients undergoing surgery alone. NAC (odds ratio [OR], 19.8; 95% confidence interval [CI], 11.8-33.5), nonwhite race (OR, 3.2; 95% CI, 1.7-6.3), and ureteral tumor location (OR, 1.6; 95% CI, 1.02-2.6) were independently associated with PR. CONCLUSIONS: Examining a large national cancer registry, we observed a higher incidence of PR in patients with UTUC receiving NAC, validating findings of prior studies. Our findings support consideration of NAC in high grade UTUC. Prospective trials will better define the impact of NAC on pathologic and survival outcomes.
Authors: Vitaly Margulis; Maneka Puligandla; Edouard J Trabulsi; Elizabeth R Plimack; Elizabeth R Kessler; Surena F Matin; Guilherme Godoy; Ajjai Alva; Noah M Hahn; Michael A Carducci; Jean Hoffman-Censits Journal: J Urol Date: 2019-11-08 Impact factor: 7.450
Authors: Brian R Winters; Navonil De Sarkar; Sonali Arora; Hamid Bolouri; Sujata Jana; Funda Vakar-Lopez; Heather H Cheng; Michael T Schweizer; Evan Y Yu; Petros Grivas; John K Lee; Lori Kollath; Sarah K Holt; Lisa McFerrin; Gavin Ha; Peter S Nelson; Robert B Montgomery; Jonathan L Wright; Hung-Ming Lam; Andrew C Hsieh Journal: JCI Insight Date: 2019-05-30
Authors: David D'Andrea; Surena Matin; Peter C Black; Firas G Petros; Homayoun Zargar; Colin P Dinney; Michael S Cookson; Wassim Kassouf; Marc A Dall'Era; John S McGrath; Jonathan L Wright; Andrew C Thorpe; Todd M Morgan; Jeffrey M Holzbeierlein; Trinity J Bivalacqua; Srikala S Sridhar; Scott North; Daniel A Barocas; Yair Lotan; Andrew J Stephenson; Bas W van Rhijn; Philippe E Spiess; Siamak Daneshmand; Shahrokh F Shariat Journal: BJU Int Date: 2020-10-14 Impact factor: 5.588