Role of perioperative chemotherapy in upper tract urothelial carcinoma patients undergoing nephroureterectomy: Analysis from the ROBUUST 2.0 Registry

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Conference Proceeding

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Eur Urol


Introduction & Objectives: In this study we assessed the role of perioperative chemotherapy (CHT) in a large multicenter cohort of patients with Upper tract Urothelial carcinoma (UTUC) undergoing nephroureterectomy (NUT).

Materials & Methods: A multicenter retrospective analysis utilizing the ROBUUST (for RObotic surgery for Upper Tract Urothelial Cancer Study) registry was performed. Baseline, preoperative and pathologic variables of three groups of patients receiving surgery only, Nad CHT or Adjuvant (Ad) CHT were compared. Categorical and continuous variables among the three subgroups were compared with Chi square and Kruskal-Wallis tests, respectively. Stage-specific Kaplan-Meier analysis was performed to compare cancer-specific survival (CSS) probabilities between patients treated with direct NUT, NadCHT prior to surgery, NUT followed by Ad-CHT.

Results: Overall, 669 of them were included in the analysis. NadCHT patients displayed a significantly higher rate of cT stage ≥ 3 (p<0.001) and clinically positive nodes (p=0.001). AdCHT group showed a higher rate of low grade complications (54.8% AdCHT vs 34.6% NUT vs 16.9% NadCHT,p<0.001), while severe complications were comparable between groups (1.7% AdCHT vs 3.1% NUT vs 2.2% NadCHT, p=0.82). At Kaplan Meier, focused to cT stage ≥ 3, patients receiving surgery only vs NadCHT vs AdCHT displayed comparable CSS probabilities (12-mo NUT 91%, Nad-NUT 80.6%,NUT+Ad-CHT 92.3%, p=0.56). When restricting survival analysis to clinically positive nodes (cN+) patients, patients who required Ad-CHT after surgery had a significantly lower survival (12-mo:74.1%, p=0.04), while Nad-CHT and direct NUT rates were comparable (12-mo 90.3% and 89.8%, respectively).

Conclusions: According to our retrospective analysis of a large multicenter dataset, Nad-CHT in specific subgroups of high-risk patients (such as locally advanced disease and clinically positive nodes) has negligible impact on incidence of severe perioperative complications; however it does not seem to provide an advantage in terms of CSS. Further data from randomised trials are expected.



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