ArticleEuropean urology open science2025
Treatment Outcomes of Neoadjuvant Versus Adjuvant Chemotherapy in Upper Tract Urothelial Carcinoma: A Propensity Score Overlap Weighting Analysis of a Multicenter Taiwanese Cohort.
Article in European urology open science, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and objective: Systemic therapy can improve postoperative oncological outcomes in patients with high-risk upper tract urothelial carcinoma (UTUC). However, evidence comparing neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) remains inconclusive. This study aimed to evaluate survival outcomes between NAC and AC in UTUC patients. Methods: We identified patients from the Taiwan UTUC Collaboration Database who received radical nephroureterectomy and systemic chemotherapy without distant metastasis. Patients receiving immunotherapy or with clinical stage <cT2N0M0 were excluded. Propensity score overlap weighting was used to balance baseline characteristics between the NAC and AC groups. Overall (OS), cancer-specific (CSS), and recurrence-free (RFS) survival were compared. Key findings and limitations: A total of 249 patients were included, with 45 receiving NAC and 204 receiving AC. After balancing baseline characteristics using overlap weighting, the NAC group showed significantly lower pathological stage, less lymph node involvement, and less lymphovascular invasion. No significant difference was observed in OS, CSS, or RFS between the groups. However, when stratified by treatment response, NAC nonresponders had significantly worse survival than AC patients. The main limitation of this study lies in its retrospective nature. Conclusions and clinical implications: NAC and AC demonstrated no significant differences in survival outcomes, but response to NAC was an important prognostic factor for survival. Given the difficulty in accurately predicting a response to NAC, AC may be a more favorable treatment strategy in patients with UTUC. However, prospective randomized trials are still needed to validate our findings. Patient summary: In this study, we compare the effects of two types of chemotherapy for upper tract urothelial carcinoma (UTUC): neoadjuvant chemotherapy (NAC), which is given before surgery, and adjuvant chemotherapy (AC), which is given after surgery. We found that only patients who responded well to NAC had survival outcomes similar to those who received AC. Based on this, we suggest that unless we can accurately predict who will respond to NAC, AC should be the preferred treatment for UTUC patients.
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