Faculty Bibliography

OBJECTIVES/OBJECTIVE:To evaluate the impact of cisplatin-based neoadjuvant chemotherapy (NAC) in patients who underwent nephroureterectomy for high grade (HG) upper tract urothelial carcinoma (UTUC). METHODS:Retrospective review was conducted of patients with HG UTUC from 2011 to 2017 who underwent nephroureterectomy at two institutions. Patients with eGFR > 50 mL/min/1.73m2 were considered eligible for NAC and were referred for evaluation of NAC prior to nephroureterectomy. Patient demographics, kidney function, clinical and pathologic response rates and outcomes were analyzed. RESULTS:Of 95 patients with HG UTUC meeting inclusion criteria (mean age 72.3 years, mean pre-op eGFR 57.0 mL/min/1.73m2), 61 patients were considered eligible for NAC with eGFR > 50 mL/min/1.73m2, of which 25 (41%) received NAC. Of the patients who received NAC, 80% (20/25) of patients had clinical response on imaging and 80% (20/25) had pathologic response (<pT2N0 disease) on nephroureterectomy. On final pathology, only 20% of the NAC group had ≥pT2 disease compared to 64% of patients who proceeded directly to surgery (p = 0.001). Patients who received NAC had significantly longer progression free survival (p=0.051) and overall survival (p=0.052) compared to patients who proceeded directly to surgery. No patients progressed or were deemed ineligible for surgery due to NAC. CONCLUSIONS:Cisplatin-based NAC demonstrated a high clinical and pathologic response rate in patients with HG UTUC without compromising definitive surgical treatment. Since nephroureterectomy significantly reduces kidney function and eligibility for cisplatin-based chemotherapy after surgery, patients with HG UTUC should be considered for NAC.