Investigators have identified which patients with lymph node-positive upper tract urinary carcinoma (UTUC) might benefit from adjuvant chemotherapy following radical surgery, according to study data presented at the 37th Annual European Association of Urology Congress.
“Adjuvant chemotherapy can be a favorable treatment option for patients without positive surgical margins irrespective of the number of pathological nodes positive,” investigator Shravan Morisetty, MD, of Wayne State University School of Medicine in Detroit, Michigan, said in an oral presentation.
The study may be the first risk-stratified approach delineating selection criteria for adjuvant chemotherapy for patients with UTUC, according to Dr Morisetty.
Using the National Cancer Database, Dr Morisetty and colleagues studied 458 patients who underwent radical nephroureterectomy for non-metastatic UTUC with positive lymph nodes from 2004 to 2016.
Among patients with low-risk disease (defined as negative surgical margins and fewer than 3 positive lymph nodes) and intermediate-risk disease (negative surgical margins and 3 or more positive lymph nodes), those who received adjuvant chemotherapy had a significant 54% and 51% decreased risk for death, respectively, compared with those who did not, Dr Morisetty reported. Adjuvant chemotherapy did not have a survival benefit among patients with high-risk disease (positive surgical margins). Less than 25% of these patients survived after 3 years.
The patients with low-, intermediate-, and high-risk disease made up 56%, 20%, and 24% of the study population, respectively. Patients had a median age of 71 years and 61.8% were male. Of the 458 patients, 74.9% had negative surgical margins and 59% received adjuvant chemotherapy. The overall 3-year survival rates were 24%, 30%, and 49%, respectively. Patients had a median follow-up time of 1.85 years.
Morisetty S, Piontkowski AJ, Corsi N, et al. The impact of adjuvant chemotherapy on overall survival in patients with node-positive upper tract urothelial carcinoma (UTUC): Improving precision in medicine with a risk-stratified approach. Presented at: EAU 2022, July 1-4, 2022, Amsterdam, The Netherlands. Abstract A0300.