Pd33-09 Pathologic Down Staging With Neoadjuvant Chemotherapy as a Predictor of Oncological Outcomes for Upper Tract Urothelial Carcinoma Treated With Nephroureterectomy: A Robuust Registry Analysis

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD33)1 May 2024PD33-09 PATHOLOGIC DOWN STAGING WITH NEOADJUVANT CHEMOTHERAPY AS A PREDICTOR OF ONCOLOGICAL OUTCOMES FOR UPPER TRACT UROTHELIAL CARCINOMA TREATED WITH NEPHROURETERECTOMY: A ROBUUST REGISTRY ANALYSIS Benjamin Popokh, Raj Bhanvadia, Jacob Taylor, Antonio Franco, Zhenije 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 Singla, 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, Farshad Moghaddam, Alireza Ghoreifi, Hooman Djaladat, Riccardo Autorino, and Vitaly Margulis Benjamin PopokhBenjamin Popokh , Raj BhanvadiaRaj Bhanvadia , Jacob TaylorJacob Taylor , Antonio FrancoAntonio Franco , Zhenije WuZhenije 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 SinglaNirmish Singla , 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 , Farshad MoghaddamFarshad Moghaddam , Alireza GhoreifiAlireza Ghoreifi , Hooman DjaladatHooman Djaladat , Riccardo AutorinoRiccardo Autorino , and Vitaly MargulisVitaly Margulis View All Author Informationhttps://doi.org/10.1097/01.JU.0001008912.25331.d7.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pathologic down staging to non muscle-invasive disease (<yPT2) after neoadjuvant chemotherapy (NAC) has been proposed as a surrogate endpoint for oncologic outcomes in upper tract urothelial carcinoma (UTUC) in smaller multi-centered and single institution series. We sought to validate this hypothesis, examining whether UTUC patients undergoing radical nephroureterectomy (RNUx) who achieved <ypT2 after NAC had comparable oncologic outcomes to those who were inherently low stage without NAC (<pT2) using a large, international, multi-centered database (ROBUUST 2.0). METHODS: We identified 2,434 cases of UTUC across 16 institutions. Primary exclusion criteria included non-urothelial histology, prior or concomitant cystectomy, receipt of non-platinum based NAC or adjuvant chemotherapy, and pathologically invasive (pT2-T4) or node positive disease (pN+). Patients were stratified into two cohorts based on receipt of NAC (<ypT2) or no NAC (<pT2). Recurrence free (RFS), cancer specific (CSS), and overall survival (OS) were examined using the Kaplan-Meier method and multivariable Cox regression. RESULTS: 683 patients met inclusion criteria, with 93% identified as <pT2 and 7% identified as <ypT2. Patients who were <ypT2 were more likely to be cT3-T4 (29.8% vs 2.3%, p<0.01), cN+ (15.5% vs 3.3%, p<0.01), and high grade (93.2% vs5 3.2%, p<0.01). Patients who were <ypT2 showed equivalent RFS (p=0.8), CSS (p=0.2) and OS (p=0.3) compared to patients who were <pT2. On cox regression, there was no difference in RFS (HR:0.7, p=0.2), and OS (HR:2.0, p=0.1), between <ypT2 and <pT2 cohorts. Cancer mortality was worse for patients with de novo non-invasive disease (<pT2) compared to <ypT2, but results did not reach significance (HR: 3.8, 95% CI: 0.99-14.9, p=0.05). CONCLUSIONS: Despite worse upfront clinical T and N staging, UTUC patients achieving <ypT2 exhibit comparable oncological outcomes to those inherently non-muscle invasive (<pT2) at RNUx. The results support the use of pathologic down-staging as a valid surrogate endpoint for oncologic outcomes in NAC studies and trials in UTUC. Further prospective studies validating these results and improving patient selection for NAC are needed. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e713 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Benjamin Popokh More articles by this author Raj Bhanvadia More articles by this author Jacob Taylor More articles by this author Antonio Franco More articles by this author Zhenije 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 Singla 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 Farshad Moghaddam 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 Vitaly Margulis More articles by this author Expand All Advertisement PDF downloadLoading ...