Upper tract urothelial carcinoma (UTUC) tends to metastasize and respond poorly to chemotherapy, new study findings confirm.

In a case series of 250 patients with UTUC, 56 (22.4%) presented with stage IV disease. The most common metastatic sites were lung (39.6%), distant lymph nodes (39.2%), bone (19.6%), liver (18.0%), and adrenal gland (7.2%). Only 1 in 10 patients experienced local recurrence. For treatment, 213 patients received first-line chemotherapy. Two-thirds received a cisplatin-based regimen including gemcitabine plus cisplatin or cisplatin, gemcitabine, and paclitaxel or nab-paclitaxel.

The overall response rate was only 28.7% and the median progression-free survival time was only 5.0 months, Xinan Sheng, MD, of Peking University Cancer Hospital & Institute, Beijing, China, and colleagues reported in Urologic Oncology. Overall survival time was 18.0 months.

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On multivariate analyses, a stage IV diagnosis, 3 or more sites of metastases, no response to chemotherapy, and 2 or fewer cycles of chemotherapy independently predicted poor overall survival.

UTUC is more prone to metastasize than recur locally and is thought to have low chemosensitivity, according to Dr Sheng’s team. “These 2 characteristics should be taken into treatment considerations,” they stated.


Li X, Li S, Chi Z, et al. Clinicopathological characteristics, prognosis, and chemosensitivity in patients with metastatic upper tract urothelial carcinoma [published online July 10, 2020]. Urol Oncol. doi: 10.1016/j.urolonc.2020.06.010