Perioperative chemotherapy prior to nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) can improve oncologic and survival outcomes, a recent meta-analysis confirms.
The findings “provide support for the beneficial effect of perioperative chemotherapy in patients with UTUC, who are planned for RNU; we also found that patients with locally advanced UTUC have a tangible benefit,” a team led by Shahrokh F. Shariat, MD, of the Medical University of Vienna in Austria, reported in the International Journal of Clinical Oncology.
The meta-analysis, which included 22 studies and 15,378 patients with non-metastatic UTUC, found that neoadjuvant chemotherapy (NAC) prior to RNU was significantly associated with a nearly 6.5-fold and 19-fold increased likelihood of pathologic downstaging and pathologic complete response, respectively. NAC was significantly associated with a 47% decreased risk of death and 61% decreased risk of cancer-specific mortality compared with RNU alone.
Adjuvant chemotherapy was significantly associated with a 35% decreased risk of metastasis and 34% decreased risk of cancer-specific death. The study found no significant association between adjuvant chemotherapy and overall survival among patients as a whole, but among patients with locally advanced UTUC, adjuvant chemotherapy was significantly associated with a 20% reduced risk of death. In addition, adjuvant chemotherapy was significantly associated with a 33% decreased risk of cancer-related death.
“We believe that all patients considered for RNU should be informed about risks, benefits, and alternatives to NAC with cisplatin-based conventional chemotherapy,” Dr Shariat’s team concluded. “If they have non-organ confined or lymph-node metastasis after RNU and have not received NAC, they should be offered AC with platinum-based chemotherapy (carboplatin or cisplatin based on renal function and comorbidities).”
Quhal F, Mori K, Motlagh RS, et al. Efficacy of neoadjuvant and adjuvant chemotherapy for localized and locally advanced upper tract urothelial carcinoma: a systematic review and meta‑analysis [published online March 23, 2020]. Int J Clin Oncol. doi: 10.1007/s10147-020-01650-9