Neoadjuvant chemotherapy is associated with longer overall survival in patients with upper tract urothelial carcinoma (UTUC) and lymph node involvement, according to an analysis of real-world data presented at American Society of Clinical Oncology’s 2023 Genitourinary Cancers Symposium in San Francisco, California.

Overall survival was significantly longer among patients receiving neoadjuvant vs adjuvant chemotherapy: median 47.1 vs 20.2 months, Karan Jatwani, MBBS, of Roswell Park Comprehensive Cancer Center in Buffalo, New York, reported for his team. On multivariable analysis, adjuvant chemotherapy independently predicted a 38% increased risk for early death after adjustment for demographics, clinical T stage, comorbidities, and insurance status.

For the retrospective study, the investigators queried the 2004-2018 National Cancer Database and identified 862 adults with cTanyN1-3M0 UTUC who underwent radical nephroureterectomy. Of these, 362 (42%) received neoadjuvant chemotherapy and 500 (58%) received adjuvant chemotherapy. Receipt of neoadjuvant vs adjuvant chemotherapy did not differ significant by clinical nodal stage. A significantly higher proportion of patients with cT1-2 UTUC received neoadjuvant chemotherapy (27.9% vs 11.8%). A significantly higher proportion of patients with cT3-4 UTUC received adjuvant chemotherapy (38.9% vs 57.4%). The database did not specify which chemotherapy regimens patients received.

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Adjuvant chemotherapy has been regarded as a standard-of-care in high-risk UTUC based on results in the POUT trial, the investigators noted, but fewer than 10% of patients in the POUT trial had lymph node involvement.

“Our group found that neoadjuvant chemotherapy was associated with significantly longer overall survival compared with adjuvant chemotherapy in patients with clinically node positive UTUC who underwent radical nephroureterectomy,” coinvestigator Arya Mariam Roy, MBBS, of Roswell Park Comprehensive Cancer Center said in an interview. “Based on these results, neoadjuvant chemotherapy can be preferred over adjuvant chemotherapy for node-positive UTUC.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Jatwani K, Roy AM, Attwood K, et al. Neoadjuvant chemotherapy (NAC) versus adjuvant chemotherapy (AC) in patients with clinically node-positive upper tract urothelial cancer (UTUC) who underwent radical nephroureterectomy (RNU). ASCO GU 2023, San Francisco, California, February 16-18. Abstract 486.