Mp38-03 Predictors and Outcome of Lymph Node Involvement Following Neoadjuvant Chemotherapy and Radical Nephroureterectomy for Primary Upper Tract Urothelial Carcinoma (Robuust Collaborative Group)

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP38)1 May 2024MP38-03 PREDICTORS AND OUTCOME OF LYMPH NODE INVOLVEMENT FOLLOWING NEOADJUVANT CHEMOTHERAPY AND RADICAL NEPHROURETERECTOMY FOR PRIMARY UPPER TRACT UROTHELIAL CARCINOMA (ROBUUST COLLABORATIVE GROUP) Farshad Sheybaee Moghaddam, Alireza Ghoreifi, Erika Wood, Antonio Franco, Zhenjie Wu, Linhui Wang, Alessandro Antonelli, Francesco Ditonno, Firas Abdollah, Marco Finati, Giuseppe Simone, Gabriele Tuderti, Emma Helstrom, Andreas Correa, Ottavio De Cobelli, Matteo Ferro, Francesco Porpiglia, Daniele Amparore, Antonio Tufano, Sisto Perdonà, Stephan Broenimann, Nirmish Sigla, Margaret F. Meagher, Ithaar H. Derweesh, Dinno F. Mendiola, Mark L. Gonzalgo, Benjamine M. Eilender, Reza Mehrazin, Sol C. Moon, Soroush Rais-Bahrami, Courtney Yong, Chandru P. Sundaram, Raj Bhanvadia, Vitaly Margulis, Riccardo Autorino, and Hooman Djaladat Farshad Sheybaee MoghaddamFarshad Sheybaee Moghaddam , Alireza GhoreifiAlireza Ghoreifi , Erika WoodErika Wood , Antonio FrancoAntonio Franco , Zhenjie WuZhenjie Wu , Linhui WangLinhui Wang , Alessandro AntonelliAlessandro Antonelli , Francesco DitonnoFrancesco Ditonno , Firas AbdollahFiras Abdollah , Marco FinatiMarco Finati , Giuseppe SimoneGiuseppe Simone , Gabriele TudertiGabriele Tuderti , Emma HelstromEmma Helstrom , Andreas CorreaAndreas Correa , Ottavio De CobelliOttavio De Cobelli , Matteo FerroMatteo Ferro , Francesco PorpigliaFrancesco Porpiglia , Daniele AmparoreDaniele Amparore , Antonio TufanoAntonio Tufano , Sisto PerdonàSisto Perdonà , Stephan BroenimannStephan Broenimann , Nirmish SiglaNirmish Sigla , Margaret F. MeagherMargaret F. Meagher , Ithaar H. DerweeshIthaar H. Derweesh , Dinno F. MendiolaDinno F. Mendiola , Mark L. GonzalgoMark L. Gonzalgo , Benjamine M. EilenderBenjamine M. Eilender , Reza MehrazinReza Mehrazin , Sol C. MoonSol C. Moon , Soroush Rais-BahramiSoroush Rais-Bahrami , Courtney YongCourtney Yong , Chandru P. SundaramChandru P. Sundaram , Raj BhanvadiaRaj Bhanvadia , Vitaly MargulisVitaly Margulis , Riccardo AutorinoRiccardo Autorino , and Hooman DjaladatHooman Djaladat View All Author Informationhttps://doi.org/10.1097/01.JU.0001008700.92603.b1.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lymph node dissection (LND) is recommended for optimal staging and therapy in high-risk upper tract urothelial carcinoma (UTUC). Neoadjuvant chemotherapy (NAC) has been shown to improve oncological outcomes in this group of patients. We aimed to identify the clinical and pathological predictors of positive lymph nodes in UTUC patients who had extirpative surgery following NAC. METHODS: In this multicenter retrospective study, we utilized the ROBUUST 2.0 (ROBotic surgery for Upper tract Urothelial Cancer STudy) database. Patients without LND or missing data in pathologic lymph node status were excluded. Multivariable logistic regression was performed to evaluate the factors associated with pathological node involvement by NAC status. RESULTS: Of 2,433 UTUCs, 883 patients were included, of whom 131 had NAC. Table 1 shows baseline and clinical features. Multivariable analysis revealed high grade histology (OR 2, CI 95% 1.1–3.8, p2 (OR 1.7, CI 95% 1.1–2.6, p<0.02) and lymphovascular invasion (OR 6.8, CI 95% 4.4–10.6, p<0.001) as independent predictors of LN positivity in non-NAch group, while lymphovascular invasion (OR 34.3, CI 95% 6.8–171.9, p<0.001) was the only predictors in NAch group. Distant metastasis was higher in ypN+ compared to pN+ patients (33% vs. 13%, p=0.02) (Figure 1). Median (IQR) time to distant metastasis in ypN+ and pN+ groups were 4 (IQR 1-9) and 3 (IQR 1–6) months, respectively. With a median (IQR) follow-up of 20 (6–41) months, the rate of being alive with no recurrence was higher in the pN+ compared to ypN+ group (55% vs 33%, p<0.001). CONCLUSIONS: Lymphovascular invasion is the only predictor of lymph node involvement in patients with UTUC who had extirpative surgery following NAC. Positive lymph node status following NAC is associated with a higher rate of distant metastasis and earlier disease-specific mortaility. Effective adjuvant systemic treatment is desperately warranted in this very high-risk group. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e641 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Farshad Sheybaee Moghaddam More articles by this author Alireza Ghoreifi More articles by this author Erika Wood More articles by this author Antonio Franco More articles by this author Zhenjie Wu More articles by this author Linhui Wang More articles by this author Alessandro Antonelli More articles by this author Francesco Ditonno More articles by this author Firas Abdollah More articles by this author Marco Finati More articles by this author Giuseppe Simone More articles by this author Gabriele Tuderti More articles by this author Emma Helstrom More articles by this author Andreas Correa More articles by this author Ottavio De Cobelli More articles by this author Matteo Ferro More articles by this author Francesco Porpiglia More articles by this author Daniele Amparore More articles by this author Antonio Tufano More articles by this author Sisto Perdonà More articles by this author Stephan Broenimann More articles by this author Nirmish Sigla More articles by this author Margaret F. Meagher More articles by this author Ithaar H. Derweesh More articles by this author Dinno F. Mendiola More articles by this author Mark L. Gonzalgo More articles by this author Benjamine M. Eilender More articles by this author Reza Mehrazin More articles by this author Sol C. Moon More articles by this author Soroush Rais-Bahrami More articles by this author Courtney Yong More articles by this author Chandru P. Sundaram More articles by this author Raj Bhanvadia More articles by this author Vitaly Margulis More articles by this author Riccardo Autorino More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement PDF downloadLoading ...