Open Access

ARTICLE

Chemotherapy increases survival and downstaging of upper tract urothelial cancer

Facundo Davaro¹, Allison May¹, Coleman McFerrin², Syed J. Raza¹, Sameer Siddiqui¹, Zachary Hamilton¹

1 Division of Urology, Department of Surgery, Saint Louis University, St Louis, Missouri, USA
2 Saint Louis University School of Medicine, St Louis, Missouri, USA
Address correspondence to Dr. Zachary Hamilton, Division of Urology, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO 63110 USA

Canadian Journal of Urology 2019, 26(5), 9938-9944.

Abstract

Introduction: To evaluate the overall survival and pathologic downstaging effect of neoadjuvant chemotherapy for upper tract urothelial cell carcinoma.
Materials and methods: The National Cancer Database (NCDB) was queried for patients with stage II-IV upper tract urothelial cell carcinoma undergoing definitive surgical resection (nephroureterectomy) from 2004-2015. Patients with metastatic disease were excluded. Cohorts were stratified by receipt of neoadjuvant chemotherapy (NAC). Kaplan-Meier analysis and Cox regression were used to evaluate overall survival. Logistic regression was used to predict the odds of pathologic downstaging to non-invasive disease (< pT2). Propensity score matched analysis was performed between groups.
Results: A total of 3634 patients were identified with non-metastatic stage II-IV disease undergoing surgical resection; 3364 received no chemotherapy and 270 received NAC. Patients undergoing NAC had a 10.9% rate of downstaging to non-invasive disease (OR 6.35, p < 0.001). Moreover, on Kaplan-Meier analysis, median survival was 27.3 months and 44.8 months for no chemotherapy versus NAC, respectively (log-rank, p = 0.001). Cox regression for death also revealed benefits for receiving NAC (HR 0.67, p < 0.001). Findings were confirmed on propensity score matching (532 matched patients). After matching, Cox regression for death noted improvement with neoadjuvant as compared to no chemotherapy (HR 0.61, p < 0.001).
Conclusion: Neoadjuvant chemotherapy increases likelihood of downstaging to non-invasive disease in patients with upper tract urothelial cell carcinoma. Chemotherapy also provides an overall survival benefit in patients undergoing nephroureterectomy.

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