Impact of adjuvant chemotherapy for patients with locally advanced upper tract urothelial carcinoma in real-world clinical practice.

Introduction: The impact of adjuvant chemotherapy (ACT) using regimens including gemcitabine and platinum on the improvement of the prognosis of patients with locally advanced upper tract urothelial carcinoma (UTUC) has been recently demonstrated. This study aimed to determine the utility of ACT for patients with locally advanced UTUC in real-world clinical practice and the differences in efficacy among regimens.

Methods: Of 206 UTUC patients who underwent radical nephroureterectomy, 78 were pathologically diagnosed as T3 or higher and/or had pathologically identified lymph node metastasis; 36 in the ACT group and 42 in the non-ACT group were evaluated for patient background, recurrence, and prognosis. In the ACT group, either cisplatin (GC group, 12 cases) or carboplatin (GCa group, 24 cases) was administered as the platinum agent to be combined with gemcitabine.

Result: The median patient age in the ACT group and that in the non-ACT group was 71 and 79 years, respectively (p<0.0001). There was no significant difference between these two groups in terms of other patient parameters. The two- and five-year cancer-specific survival (CSS ) and the two- and five-year disease-free survival (DFS) for the ACT group were 81.7%, 66.0%, 60.6%, and 56.6%, respectively, and for the non-ACT group were 68.4%, 40.5%, 42.8%, and 29.3%, respectively (p=0.0399 for CSS and p=0.0814 for DFS). There was no significant difference in CSS and DFS between the GC group and GCa group (p=0.9846 and p=0.9389, respectively).

Conclusions: In real-world clinical practice in Japan, UTUC patients who receive ACT after radical nephroureterectomy may be expected to have better cancer control than those who do not receive ACT.