ArticleWorld journal of urology2025
Neoadjuvant versus adjuvant chemotherapy for upper tract urothelial carcinoma in the setting of clinical node positive disease: analysis of the ROBUUST registry.
Article in World journal of urology, 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
objectiveTo compare the outcomes of Neoadjuvant Chemotherapy (NAC) versus Adjuvant chemotherapy (AC) in upper tract urothelial carcinoma (UTUC) with Clinical Nodal Disease (CN+).
methodsMulticenter retrospective analysis of patients with CN + who underwent RNU from the ROBUUST (ROBotic surgery for Upper Tract Urothelial cancer STudy) database. Patients were divided into those who received NAC versus AC. Primary outcome was all-cause mortality (ACM). Secondary outcomes were cancer-specific mortality (CSM) and recurrence. Cox-regression multivariable analysis (MVA) was used to elucidate predictive factors for ACM, CSM, and recurrence. Kaplan-Meier Analysis (KMA) was performed to analyze 5-year overall survival (OS), cancer-specific survival (CSS), and recurrence free survival (RFS).
results102 patients were analyzed (53 neoadjuvant/49 adjuvant; median follow-up 17.0 months). Groups did not differ with respect to median age at diagnosis (p = 0.692), BMI (p = 0.551), clinical tumor size (p = 0.514), or ECOG performance status (p = 0.44). MVA revealed receipt of NAC to be associated with improved ACM (HR 0.36, p = 0.023), CSM (HR 0.38, p = 0.046), and recurrence (HR 0.51, p = 0.048). KMA comparing NAC and AC revealed significantly greater 5-year OS (65% vs. 37%, p = 0.004), 5-year CCS (63% vs. 29%, p = 0.010), and 5-year RFS (50% vs. 17%, p = 0.046) for NAC.
conclusionsIn the setting of clinical node positive disease, NAC was associated with improved survival outcomes. Our findings suggest that presurgical systemic chemotherapy may be preferred in the subpopulation of patients with cN + prior to performance of RNU. Further investigation is requisite.
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