Among patients undergoing surgery for high-grade upper tract urothelial carcinoma, those who respond to neoadjuvant chemotherapy (NAC) may have a survival advantage over those who receive adjuvant chemotherapy (AC), according to a new study.

“Our study suggests that there is a survival advantage for patients who achieve a response, even if partial, after NAC, while patients who do not respond tend to harbor a worse prognosis with respect to patients who receive AC,” Alberto Martini, MD, of the Icahn School of Medicine at Mount Sinai in New York, and colleagues concluded in Urologic Oncology. “Our results are hypothesis-generating and further studies aimed at identifying potential responders to NAC are warranted.”

Dr Martini’s team studied 936 patients treated with radical nephroureterectomy for upper tract urothelial carcinoma (UTUC). Of these, 128 (14%) received NAC and 808 (86%) received AC. The investigators found no difference in overall survival (OS) between the groups. Relative to AC, however, patients who responded to NAC (demonstrating a pT stage at least 1 category lower than the pre-chemotherapy cT stage along with pN0) had a significant 55% reduced risk of death, whereas those who did not respond to NAC had a significant 41% increased risk of death, Dr Martini and his collaborators reported.

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The 5-year OS rates were higher for NAC responders compared with nonresponders and AC recipients: 71% vs 26% vs 43%, respectively.

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For the study, Dr Martini’s team abstracted information from the National Cancer Database. The study population had a median age of 69 years and was 63% male. The investigators defined AC as the administration of chemotherapy within 6 months after surgery and NAC as administration of chemotherapy within 6 months prior to surgery.


Martini A, Falagario UG, Waingankar N, et al. Neoadjuvant versus adjuvant chemotherapy for upper tract urothelial carcinoma [published online April 10, 2020]. Urol Oncol. doi: 10.1016/j.urolonc.2020.03.008