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Objective <p>To compare the outcomes of Neoadjuvant Chemotherapy (NAC) versus Adjuvant chemotherapy (AC) in upper tract urothelial carcinoma (UTUC) with Clinical Nodal Disease (CN+).</p> Methods <p>Multicenter retrospective analysis of patients with CN + who underwent RNU from the ROBUUST (ROBotic surgery for Upper Tract Urothelial cancer STudy) database. Patients were divided into those who received NAC versus AC. Primary outcome was all-cause mortality (ACM). Secondary outcomes were cancer-specific mortality (CSM) and recurrence. Cox-regression multivariable analysis (MVA) was used to elucidate predictive factors for ACM, CSM, and recurrence. Kaplan-Meier Analysis (KMA) was performed to analyze 5-year overall survival (OS), cancer-specific survival (CSS), and recurrence free survival (RFS).</p> Results <p>102 patients were analyzed (53 neoadjuvant/49 adjuvant; median follow-up 17.0 months). Groups did not differ with respect to median age at diagnosis (<i>p</i> = 0.692), BMI (<i>p</i> = 0.551), clinical tumor size (<i>p</i> = 0.514), or ECOG performance status (<i>p</i> = 0.44). MVA revealed receipt of NAC to be associated with improved ACM (HR 0.36, <i>p</i> = 0.023), CSM (HR 0.38, <i>p</i> = 0.046), and recurrence (HR 0.51, <i>p</i> = 0.048). KMA comparing NAC and AC revealed significantly greater 5-year OS (65% vs. 37%, <i>p</i> = 0.004), 5-year CCS (63% vs. 29%, <i>p</i> = 0.010), and 5-year RFS (50% vs. 17%, <i>p</i> = 0.046) for NAC.</p> Conclusions <p>In the setting of clinical node positive disease, NAC was associated with improved survival outcomes. Our findings suggest that presurgical systemic chemotherapy may be preferred in the subpopulation of patients with cN + prior to performance of RNU. Further investigation is requisite.</p>

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Neoadjuvant versus adjuvant chemotherapy for upper tract urothelial carcinoma in the setting of clinical node positive disease: analysis of the ROBUUST registry

  • 期刊论文

  • 发表日期：

    2025年11月26日

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  • Margaret F. Meagher,
  • Zhenjie Wu,
  • Antonio Franco,
  • Linhui Wang,
  • Vitaly Margulis,
  • Raj Bhanvadia,
  • Firas Abdollah,
  • Marco Finati,
  • Alessandro Antonelli,
  • Francesco Ditonno,
  • Nirmish Singla,
  • Stephan Brönimann,
  • Giuseppe Simone,
  • Flavia Proietti,
  • Gabriele Tuderti,
  • Dhruv Puri,
  • Natalie Birouty,
  • Giacomo Musso,
  • Mai Dabbas,
  • Soroush Rais-Bahrami,
  • Sol C. Moon,
  • Matteo Ferro,
  • Marco Tozzi,
  • Francesco Porpiglia,
  • Enrico Checcucci,
  • Andreas F. Correa,
  • Emma Helstrom,
  • Mark L. Gonzalgo,
  • Dinno F. Mendiola,
  • Sisto Perdonà,
  • Antonio Tufano,
  • Benjamine M. Eilender,
  • Reza Mehrazin,
  • Courtney Yong,
  • Chandru P. Sundaram,
  • Alireza Ghoreifi,
  • Hooman Djaladat,
  • Riccardo Autorino,
  • Ithaar H. Derweesh

摘要

Objective

To compare the outcomes of Neoadjuvant Chemotherapy (NAC) versus Adjuvant chemotherapy (AC) in upper tract urothelial carcinoma (UTUC) with Clinical Nodal Disease (CN+).

Methods

Multicenter retrospective analysis of patients with CN + who underwent RNU from the ROBUUST (ROBotic surgery for Upper Tract Urothelial cancer STudy) database. Patients were divided into those who received NAC versus AC. Primary outcome was all-cause mortality (ACM). Secondary outcomes were cancer-specific mortality (CSM) and recurrence. Cox-regression multivariable analysis (MVA) was used to elucidate predictive factors for ACM, CSM, and recurrence. Kaplan-Meier Analysis (KMA) was performed to analyze 5-year overall survival (OS), cancer-specific survival (CSS), and recurrence free survival (RFS).

Results

102 patients were analyzed (53 neoadjuvant/49 adjuvant; median follow-up 17.0 months). Groups did not differ with respect to median age at diagnosis (p = 0.692), BMI (p = 0.551), clinical tumor size (p = 0.514), or ECOG performance status (p = 0.44). MVA revealed receipt of NAC to be associated with improved ACM (HR 0.36, p = 0.023), CSM (HR 0.38, p = 0.046), and recurrence (HR 0.51, p = 0.048). KMA comparing NAC and AC revealed significantly greater 5-year OS (65% vs. 37%, p = 0.004), 5-year CCS (63% vs. 29%, p = 0.010), and 5-year RFS (50% vs. 17%, p = 0.046) for NAC.

Conclusions

In the setting of clinical node positive disease, NAC was associated with improved survival outcomes. Our findings suggest that presurgical systemic chemotherapy may be preferred in the subpopulation of patients with cN + prior to performance of RNU. Further investigation is requisite.