Combined neoadjuvant and adjuvant therapy versus adjuvant therapy in high-risk upper tract Urothelial carcinoma: a propensity matched multicenter analysis of robust 2.0 international collaborative group
Recommended Citation
Eraky A, Ben-David R, Bignante G, Wu Z, Derweesh IH, Margulis V, Abdollah F, Antonelli A, Singla N, Simone G, Bahram-Rais S, Ferro M, Porpiglia F, Correa AF, Gonzalgo ML, Perdonà S, Sundaram CP, Yoshida T, Djaladat H, Autorino R, Mehrazin R. Combined neoadjuvant and adjuvant therapy versus adjuvant therapy in high-risk upper tract Urothelial carcinoma: a propensity matched multicenter analysis of robust 2.0 international collaborative group. Eur Urol 2025; 87(S1):866.
Document Type
Conference Proceeding
Publication Date
3-1-2025
Publication Title
Eur Urol
Abstract
Introduction & Objectives: Combined neoadjuvant and adjuvant therapy (CNAAT) has shown potential survival benefits in urothelial carcinoma (UC) of the bladder, but its efficacy in upper tract UC (UTUC) is unclear. High-risk features—clinical stage 2 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 CNAAT versus adjuvant therapy (AT) alone in high-risk UTUC patients who underwent nephroureterectomy (NU). Materials & Methods: We conducted a retrospective analysis of 1,718 patients who underwent NU for UTUC between 2015 and 2023 at 17 centers across the United States, Europe, and Asia. High-risk patients were identified based on the above criteria. Propensity score matching based on pathological T/N stages, resulting in 90 matched patients: 45 receiving CNAAT and 45 receiving AT. Kaplan-Meier survival curves and Cox proportional hazards models were employed to assess overall survival (OS), cancer-specific survival (CSS), metastasis-free survival (MFS), and recurrence-free survival (RFS). Results: The matched cohort had advanced pathological stages, with 69% having pathological T3/T4 tumors and 18% nodal involvement, with a median follow-up of 18 months. After adjusting for variables, CNAAT and AT groups had comparable oncological outcomes: 2-year OS (72% vs. 74%; p = 0.85), CSS (76% vs. 85%; p = 0.43), RFS (43% vs. 40%; p = 0.84), or MFS (44% vs. 48%; p = 0.89). Cox regression indicated that CNAAT did not confer a significant survival advantage over AT after adjusting for clinical and pathological factors (HR for OS: 1.15; p = 0.72). Conclusions: In this large multicenter international cohort, CNAAT did not show a significant advantage over AT alone in patients with high-risk UTUC. Larger prospective studies with longer follow-up are needed to clarify the role of multimodal therapy in UTUC management.[Figure presented].
Volume
87
Issue
S1
First Page
866
