The impact of area deprivation index on adjuvant chemotherapy utilization in UTUC patients, results from a retrospective analysis

Document Type

Conference Proceeding

Publication Date

3-1-2026

Publication Title

Eur Urol

Keywords

Urology & Nephrology

Abstract

Introduction & Objectives: Following the publication of the POUT trial, adjuvant chemotherapy became a standard treatment for patients with UTUC stage pT2–T4 or N+ disease. However, selected patients had already received such therapy before its formal adoption. Socioeconomic disparities have long influenced access to cancer care and may affect treatment selection. In this study we tested the hypothesis that socioeconomic differences contributed to inequities in access to adjuvant chemotherapy in patients with advanced UTUC. Materials & Methods: Data of patients with advanced UTUC (stage ≥pT2 or N+) who underwent surgery between 2004–2019 were retrieved from Michigan Department of Health and Human Services. Patients with metastatic disease, who underwent neoadjuvant therapy, or with missing follow-up data were excluded. Demographic and disease related data were collected, including Age, Year of Diagnosis, ADI, Sex, Race, Tobacco Consumption, Marital Status, Insurance, County Type, Histology, T Stage, Nodal Status and Area Deprivation Index (ADI). ADI is a score encompassing 17 different features used to assess the level of socioeconomic deprivation of a neighborhood; higher ADI are associated qith more deprived areas. Patients were subsequently stratified in High or Low ADI categories, depending on their ADI levels compared to the national median. The primary endpoint was receipt of adjuvant chemotherapy. A logistic regression model adjusted for demographic, clinical, and socioeconomic factors evaluated the association between ADI and adjuvant treatment use. Results: Among 543 patients, 177 (32.5%) belonged to the low-ADI group (the least deprived) and 366 (67.5%) to the high-ADI group (the most deprived). Median age was 73 years (IQR 65-80) with most of the patients being male (58.7%), Non-Hispanic White (90.4%), and married (60.8%). Adjuvant chemotherapy was administered in 96 (17.7%) patients. High-ADI patients were more often Black (9% vs 1.7%, p=0.002), more frequently residing in non-metropolitan areas (26% vs 9%, p<0.001), and less frequently treated with adjuvant therapy (14.8% vs 23.7%, p=0.01). At the multivariable logistic regression higher ADI was an independent predictor of lower odds of adjuvant treatment. Specifically, for every 10-unit increase in ADI percentile, patients were 14% less likely to be treated with adjuvant chemotherapy (OR: 0.86 [95%CI 0.77-0.96] p=0.007). Conclusions: Socioeconomic disparities have been playing and still play a role in the management of advanced UTUC. Our data show discrepancy among access to adjuvant chemotherapy in patients undergoing surgery for UTUC depending on the socio-economic status as depicted by ADI. In this context, further efforts should be made in order to guarantee equity in access to care among the general population.

Volume

89

First Page

1

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