Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy

Chih Chin Yu, Chao Hsiang Chang, Jen Kai Fang, Steven K. Huang, Wen Hsin Tseng, Hsiang Ying Lee, Hsin Chih Yeh, I. Hsuan Alan Chen, Jen Tai Lin, Pi Che Chen, Ian Seng Cheong, Thomas Y. Hsueh, Yuan Hong Jiang, Yu Khun Lee, Wei Chieh Chen, Shih Hsiu Lo, Po Hung Lin, Shian Shiang Wang, Chao Yuan Huang, Chia Chang WuJen Shu Tseng, Shu Yu Wu, Yao Chou Tsai

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Purpose: The purpose of this study is to evaluate the rates of pathological complete response (ypT0N0/X) and pathological response (ypT1N0/X or less) in patients with upper tract urothelial cancer who were treated with neo-adjuvant chemotherapy and to examine their impact on oncological outcomes. Methods: This study is a multi-institutional retrospective analysis of patients with high-risk upper tract urothelial cancer who underwent neoadjuvant chemotherapy and radical nephroureterectomy between 2002 and 2021. Logistic regression analyses were used to investigate all clinical parameters for response after neoadjuvant chemotherapy. Cox proportional hazard models were performed to assess the effect of the response on the oncological outcomes. Results: A total of 84 patients with UTUC who received neo-adjuvant chemotherapy were identified. Among them, 44 (52.4%) patients received cisplatin-based chemotherapy, and 22 (26.2%) patients had a carboplatin-based regimen. The pathological complete response rate was 11.6% (n = 10), and the pathological response rate was 42.9% (n = 36). Multifocal tumors or tumors larger than 3 cm significantly reduced the odds of pathological response. In the multivariable Cox proportional hazard model, pathological response was independently associated with better overall survival (HR 0.38, p = 0.024), cancer-specific survival (HR 0.24, p = 0.033), and recurrence-free survival (HR 0.17, p = 0.001), but it was not associated with bladder recurrence-free survival (HR 0.84, p = 0.69). Conclusion: Pathological response after neo-adjuvant chemotherapy and radical nephroureterectomy is strongly associated with patient survival and recurrence, and it might be a good surrogate for evaluating the efficacy of neo-adjuvant chemotherapy in the future.

Original languageEnglish
Pages (from-to)1274-1281
Number of pages8
JournalJournal of the Formosan Medical Association
Volume122
Issue number12
DOIs
Publication statusPublished - Dec 2023

Keywords

  • Chemotherapy
  • Neo-adjuvant
  • Oncological outcomes
  • Upper tract urothelial cancer

ASJC Scopus subject areas

  • General Medicine

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