Login to Access Video or Poster Abstract: MP71-12
Sources of Funding: none

Introduction

The benefit of neoadjuvant chemotherapy (NAC) for patients with locally advanced upper tract urothelial carcinoma (UTUC) remain unclear. The purpose of this study was to access safety and effectiveness of platinum-based NAC for locally advanced UTUC.

Methods

From Feb 1995 to Sep 2016, we underwent radical nephroureterectomy for consecutive 229 patients with UTUC at a single institute. Of these, we identified 50 patients who received NAC and 179 patients without NAC. We selected pair-matched patients from with and without NAC using propensity score by logistic analysis. We retrospectively evaluated the tumor response, post-therapy pathological down staging and toxicity between pair-matched patients. Variables for propensity score matching included age, sex, clinical TNM stage, diabetes, tumor location. Disease free and overall survivals were evaluated using Kaplan – Meier methods with log – lank test between two groups: those with and without NAC. Multivariate Cox regression analysis was performed for independent factor for overall survival.

Results

We statistically selected pair-matched 45 patients in each group. The regimens in the NAC group were gemcitabine and carboplatin for 31 cases, gemcitabine and cisplatin for 13 cases, or docetaxel, ifosfamide and nedaplatin for 1 cases. There were no significant differences in patient characteristics between the groups. Median follow up periods in NAC and control group were 21 and 39 months. No severe adverse event associated with NAC was observed. The median response rate in NAC group was 39%. Pathological down staging in primary tumor was achieved in 29 (64%) patients, and it was significantly higher compared with control group (n = 11, 24%). Platinum-based NAC for locally advanced UTUC significantly prolonged progression free survival (P = 0.015) and overall survival (P = 0.025).?In multivariate Cox regression analysis, NAC was selected as an independent predictor for prolonged overall survival (P = 0.008, HR: 0.25, 95%CI: 0.90-0.70)

Conclusions

Although present data are preliminary, the platinum-based NAC for advanced UTUC seems to have a potential to improve outcomes. Further prospective randomized studies are needed to confirm the benefit of NAC in patients with locally advanced UTUC.

Funding

none