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The role of perioperative chemotherapy for upper tract urothelial carcinoma patients treated with radical nephroureterectomy

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Abstract

Purpose

To summarize evidence regarding the use of neoadjuvant (NAC) and adjuvant chemotherapy (AC) among patients treated with radical nephroureterectomy (RNU).

Methods

A comprehensive literature search of PubMed (MEDLINE), EMBASE and the Cochrane library was performed to identify any original or review article on the role of perioperative chemotherapy for UTUC patients treated with RNU.

Results

With regards to NAC, retrospective studies consistently suggested that it may be associated with better pathological downstaging (pDS) ranging from 10.8 to 80% and complete response (pCR) ranging from 4.3 to 15%, while decreasing the risk of recurrence and death as compared to RNU alone. Even higher pDS ranging from 58 to 75% and pCR ranging from 14 to 38% were observed in single-arm phase II trials. With regards to AC, retrospective studies provided conflicting results although the largest report from the National Cancer Database suggested an overall survival benefit in pT3–T4 and/or pN + patients. In addition, a phase III randomized controlled trial showed that the use of AC was associated with a disease-free survival benefit (HR = 0.45; 95% CI = [0.30–0.68]; p = 0.0001) in pT2–T4 and/or pN + patients with acceptable toxicity profile. This benefit was consistent in all subgroups analyzed.

Conclusions

Perioperative chemotherapy improves oncological outcomes associated with RNU. Given the impact of RNU on renal function, the rational is stronger for the use of NAC which impacts final pathology and potentially prolongs survival. However, the level of evidence is stronger for the use of AC that has been proven to decrease the risk of recurrence after RNU with a potential survival benefit.

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The authors declare no funding. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière, Urology, Sorbonne University, 75013, Paris, France

    Ugo Pinar, Pietro Grande, Morgan Rouprêt & Thomas Seisen

  2. Department of Urology, San Giovanni Battista Hospital, Città Della Salute E Della Scienza and University of Turin, Turin, Italy

    Giorgio Calleris & Paolo Gontero

  3. Division of Urology, Geneva University Hospitals, Geneva, Switzerland

    Elisabeth Grobet-Jeandin & Daniel Benamran

  4. Department of Medical Oncology, Hopital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP Centre, Paris, France

    Constance Thibault

Authors
  1. Ugo Pinar
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  2. Giorgio Calleris
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  3. Elisabeth Grobet-Jeandin
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  4. Pietro Grande
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  5. Daniel Benamran
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  6. Constance Thibault
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  7. Paolo Gontero
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  8. Morgan Rouprêt
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  9. Thomas Seisen
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Contributions

UP participated in writing of the paper, literature review and data collection. GC participated in writing of the paper, literature review and data collection. EG-J participated in writing of the paper, literature review and data collection. PG participated in writing of the paper, literature review and data collection. DB participated in writing of the paper, literature review and data collection. CT participated in writing of the paper, literature review and data collection. PG participated in writing of the paper, literature review and data collection. MR participated in research design, data collection, writing of the paper, performance of the research, data analysis. TS participated in research design, data collection, writing of the paper, performance of the research, data analysis.

Corresponding author

Correspondence to Thomas Seisen.

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Pinar, U., Calleris, G., Grobet-Jeandin, E. et al. The role of perioperative chemotherapy for upper tract urothelial carcinoma patients treated with radical nephroureterectomy. World J Urol 41, 3205–3230 (2023). https://doi.org/10.1007/s00345-023-04330-1

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  • DOI: https://doi.org/10.1007/s00345-023-04330-1

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