Login to Access Video or Poster Abstract: MP78-08
Sources of Funding: None

Introduction

Prior studies have shown a possible survival benefit of cytoreductive surgery (CS) in addition to the standard of care for the treatment of major metastatic urologic cancers, including renal cell carcinoma, prostate cancer, and bladder cancer. The objective of our study was to compare the survival outcomes of chemotherapy combined with CS (nephroureterectomy, nephrectomy, and/or ureterectomy) versus chemotherapy alone for the treatment of metastatic upper tract urothelial carcinoma (mUTUC).

Methods

We identified patients who presented with mUTUC at diagnosis in the National Cancer Data Base (NCDB) from 2004 to 2014. Only patients who had multi-agent systemic chemotherapy with or without CS were included. Multivariable logistic regression was performed to identify the predictors of receiving CS. Kaplan-Meier survival, log-rank test, and multivariable Cox regression controlled for demographics, socioeconomic factors, and tumor characteristics were used to compare the overall survival (OS) between CS and no CS groups.

Results

We included 657 patients in our study of which 202 (30.75%) underwent CS. Logistic regression showed that patients who were older (OR = 0.98, 95% CI = 0.96-1.00, P =0.038), diagnosed with ureteral cancer (OR = 0.42, 95% CI = 0.27-0.66, P < 0.001), and had cN+ disease (OR = 0.33, 95% CI = 0.21-0.54, P < 0.001) were less likely to receive CS. Patients who were treated at a community hospital (OR = 1.96, 95% CI = 1.35-2.86, P < 0.001) were more likely to receive CS. No difference was found in Charlson comorbidity index between the CS and no CS groups (P = 0.434). CS group had significantly higher median OS than no CS group (13.4 vs. 10.3 months, log-rank test P < 0.001, Figure 1). Cox regression showed that compared with chemotherapy alone, chemotherapy combined with CS was significantly associated with improved OS (HR = 0.57, 95%CI = 0.44-0.74, P < 0.001).

Conclusions

Consistent with various other malignancies, CS appears to provide a survival benefit for mUTUC. However, our study is limited by the observational study design. Studies with higher level of evidence, especially randomized controlled trials are needed to validate the findings and to better identify the patients who are most likely to benefit from CS.

Funding

None