Pd20-06 Comparative Analysis of Neoadjuvant Versus Adjuvant Therapy for Upper Tract Urothelial Carcinoma in the Setting of Clinical Node Positive Disease: Analysis of the Robuust Registry

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD20)1 May 2024PD20-06 COMPARATIVE ANALYSIS OF NEOADJUVANT VERSUS ADJUVANT THERAPY FOR UPPER TRACT UROTHELIAL CARCINOMA IN THE SETTING OF CLINICAL NODE POSITIVE DISEASE: ANALYSIS OF THE ROBUUST REGISTRY Margaret F. Meagher, Zhenjie Wu, Antonio Franco, Linhui Wang, Vitaly Margulis, Raj Bhanvadia, Firas Abdollah, Alessandro Antonelli, Marco Finati, Francesco Ditonno, Nirmish Singla, Stephan Broenimann, Guiseppe Simone, Flavia Proietti, Gabriele Tuderti, Dhruv Pruri, Soroush Rais-Bahrami, Sol Moon, Matteo Ferro, Marco Tozzi, Francesco Porpiglia, Daniele Amparore, Andreas Correa, Emma Helstrom, Mark Gonzalgo, Dinno Mendiola, Sisto Perdonà, Antonio Tufano, Benjamin Eilander, Reza Mehrazin, Courtney Young, Chandru Sundaram, Alireza Ghoreifi, Hooman Djaladat, Riccardo Autorino, and Ithaar Derweesh Margaret F. MeagherMargaret F. Meagher , Zhenjie WuZhenjie Wu , Antonio FrancoAntonio Franco , Linhui WangLinhui Wang , Vitaly MargulisVitaly Margulis , Raj BhanvadiaRaj Bhanvadia , Firas AbdollahFiras Abdollah , Alessandro AntonelliAlessandro Antonelli , Marco FinatiMarco Finati , Francesco DitonnoFrancesco Ditonno , Nirmish SinglaNirmish Singla , Stephan BroenimannStephan Broenimann , Guiseppe SimoneGuiseppe Simone , Flavia ProiettiFlavia Proietti , Gabriele TudertiGabriele Tuderti , Dhruv PruriDhruv Pruri , Soroush Rais-BahramiSoroush Rais-Bahrami , Sol MoonSol Moon , Matteo FerroMatteo Ferro , Marco TozziMarco Tozzi , Francesco PorpigliaFrancesco Porpiglia , Daniele AmparoreDaniele Amparore , Andreas CorreaAndreas Correa , Emma HelstromEmma Helstrom , Mark GonzalgoMark Gonzalgo , Dinno MendiolaDinno Mendiola , Sisto PerdonàSisto Perdonà , Antonio TufanoAntonio Tufano , Benjamin EilanderBenjamin Eilander , Reza MehrazinReza Mehrazin , Courtney YoungCourtney Young , Chandru SundaramChandru Sundaram , Alireza GhoreifiAlireza Ghoreifi , Hooman DjaladatHooman Djaladat , Riccardo AutorinoRiccardo Autorino , and Ithaar DerweeshIthaar Derweesh View All Author Informationhttps://doi.org/10.1097/01.JU.0001009556.54476.eb.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical Nodal Disease (CN+) is a negative prognostic factor in Upper Tract Urothelial Carcinoma (UTUC). Adjuvant chemotherapy (AC) following Robotic nephroureterectomy (RNU) has emerged as standard of care for high risk localized and loco-regional disease following the pivotal POUT study, while neoadjuvant chemotherapy(NAC) may be considered in select patients with UTUC as renal functional decline may preclude AC. We sought to investigate outcomes of NAC and AC in CN+UTUC. METHODS: Retrospective analysis of patients with CN+ who underwent RNU from the ROBUUST (ROBotic surgery for Upper Tract Urothelial cancer STudy) 2.0 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 (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 0.39, p=0.019) and CSM (HR 2.44, p=0.042). NAC was not associated with recurrence on MVA (p=0.958). 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 therapy may be preferred in the subpopulation of patients with cN+ prior to performance of RNU. Further investigation is requisite. Download PPTDownload PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e448 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Margaret F. Meagher More articles by this author Zhenjie Wu More articles by this author Antonio Franco More articles by this author Linhui Wang More articles by this author Vitaly Margulis More articles by this author Raj Bhanvadia More articles by this author Firas Abdollah More articles by this author Alessandro Antonelli More articles by this author Marco Finati More articles by this author Francesco Ditonno More articles by this author Nirmish Singla More articles by this author Stephan Broenimann More articles by this author Guiseppe Simone More articles by this author Flavia Proietti More articles by this author Gabriele Tuderti More articles by this author Dhruv Pruri More articles by this author Soroush Rais-Bahrami More articles by this author Sol Moon More articles by this author Matteo Ferro More articles by this author Marco Tozzi More articles by this author Francesco Porpiglia More articles by this author Daniele Amparore More articles by this author Andreas Correa More articles by this author Emma Helstrom More articles by this author Mark Gonzalgo More articles by this author Dinno Mendiola More articles by this author Sisto Perdonà More articles by this author Antonio Tufano More articles by this author Benjamin Eilander More articles by this author Reza Mehrazin More articles by this author Courtney Young More articles by this author Chandru Sundaram More articles by this author Alireza Ghoreifi More articles by this author Hooman Djaladat More articles by this author Riccardo Autorino More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...