Login to Access Video or Poster Abstract: MP71-11
Sources of Funding: none

Introduction

Upper tract urothelial carcinoma (UTUC) is histologically similar to urothelial carcinoma of the bladder, but frequently associated with high grade (HG) invasive disease at diagnosis, resulting in poor outcomes. Although Level I evidence supports the use of cisplatin based neoadjuvant chemotherapy (NAC) for patients with muscle invasive bladder cancer, there is currently no level 1 data supporting the use of peri-operative chemotherapy for patients with HG UTUC. Given the inability to accurately stage UTUC, some speculate that NAC for patients undergoing nephroureterectomy (NU) for HG UTUC may improve outcomes, considering their limited eligibility for adjuvant chemotherapy due to renal impairment. Our study objective was to evaluate the impact of NAC in patients who underwent NU for pathologically proven HG UTUC.

Methods

A retrospective review was conducted of patients with HG UTUC at our institution from 2012 to 2016 who underwent NU. As per department protocol, all patients scheduled for NU with pre-op estimated glomerular filtration rate (eGFR) > 45 mL/min per 1.73 m2 were referred for evaluation of NAC. Clinical and pathologic response rates were noted, with pre- and post-operative kidney function defined by eGFR.

Results

A total of 58 patients met inclusion criteria, with a median age was 75 years (range: 35-92) and a pre-op and post-op eGFR of 54.45 and 47.6 mL/min per 1.73 m2 respectively. 26 patients were considered eligible for NAC, of which 18 (69%) received NAC. The rate of utilization increased over time (Figure 1). 13/18 (72%) demonstrated a clinical response including 6 (33%) with a complete clinical response. Final pathology demonstrated pT0N0 in 2 patients (11%) and pTisN0 in 2 patients (11%). No patients suffered a delay or were deemed ineligible for surgery due to NAC.

Conclusions

Cisplatin based NAC demonstrated a clinical response rate in the majority of patients with HG UTUC without compromising definitive surgical treatment. Since NU significantly reduces kidney function and eligibility for cisplatin based chemotherapy, patients with HG UTUC may be considered candidates for NAC. Longer follow-up data is needed to further assess the impact of NAC on survival rates.

Funding

none