Combined neoadjuvant and adjuvant therapy versus adjuvant therapy in high-risk upper tract urothelial carcinoma: a propensity matched multicenter analysis (ROBUUST 2.0 International Collaborative Group)
Recommended Citation
Eraky A, Ben-David R, Bignante G, Wu Z, Wang L, Lee R, Correa AF, Eun DD, Antonelli A, Veccia A, Ditonno F, Abdollah F, Stephens A, Tinsley S, Sidhom D, Sundaram CP, Moon SC, Rais-Bahrami S, Gonzalgo ML, Nativ OF, Porpiglia F, Amparore D, Checcucci E, Tufano A, Perdonà S, Brönimann S, Singla N, De Cobelli O, Ferro M, Simone G, Tuderti G, Meagher MF, Derweesh IH, Yoshida T, Kinoshita H, Bhanvadia R, Zahalka AH, Margulis V, Moghaddam FS, Djaladat H, Autorino R, and Mehrazin R. Combined neoadjuvant and adjuvant therapy versus adjuvant therapy in high-risk upper tract urothelial carcinoma: a propensity matched multicenter analysis (ROBUUST 2.0 International Collaborative Group). World J Urol 2025; 43(1):234.
Document Type
Article
Publication Date
4-18-2025
Publication Title
World journal of urology
Abstract
INTRODUCTION: The efficacy of combined neoadjuvant and adjuvant therapy (CNAT) in upper tract urothelial carcinoma (UTUC) remains unclear despite its demonstrated potential in bladder urothelial carcinoma. High-risk features- clinical stage ≥ T3, node-positive disease, multifocality, high-grade pathology, hydronephrosis, and large tumor size - are associated with poor prognosis in UTUC. We investigated the oncological outcomes of CNAT versus adjuvant therapy (AT) alone in high-risk UTUC patients.
MATERIALS AND METHODS: We analyzed perioperative data from 2433 patients with UTUC (2015-2023) across 17 centers in the US, Europe, and Asia. Propensity score matching was performed using preoperative clinical T and N stages. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), and metastasis-free survival (MFS).
RESULTS: Among 285 high-risk UTUC patients, 76 matched patients (38 CNAT, 38 AT) were analyzed after matching, with a median follow-up of 15 months. CNAT and AT groups had comparable oncological outcomes: 2-year OS (72.9% vs. 71.8%; p = 0.89), CSS (76.7% vs. 75.3%; p = 0.92), RFS (30.1% vs. 39%; p = 0.97), or MFS (45.5% vs. 44.7%; p = 0.91), respectively. Cox regression showed no significant survival benefit of CNAT over AT after adjusting for clinical and pathological factors (HR for OS: 1.06; p = 0.9).
CONCLUSION: In this large multicenter international cohort, our findings suggest that CNAT does not provide a clear advantage over AT alone in patients with high-risk UTUC. Prospective randomized trials are needed to clarify the role of multimodal therapy in UTUC management.
Medical Subject Headings
Humans; Male; Female; Carcinoma; Transitional Cell/therapy/pathology/mortality; Aged; Neoadjuvant Therapy; Middle Aged; Propensity Score; Ureteral Neoplasms/therapy/pathology/mortality; Kidney Neoplasms/therapy/pathology/mortality; Chemotherapy; Adjuvant; Retrospective Studies; Treatment Outcome; Adjuvant; Neoadjuvant; Recurrence; Survival; Utuc
PubMed ID
40251401
Volume
43
Issue
1
First Page
234
Last Page
234
