Presentation Authors: Nicholas Chakiryan*, Ann Martinez-Acevedo, Lina Gao, Jen Jane Liu, Christopher Amling, Mark Garzotto, Ryan Kopp, Portland, OR
Introduction: Upper tract urothelial carcinoma (UTUC) with clinically positive regional lymph nodes (cN+) is an aggressive disease state with a high propensity for metastases and death. Current literature regarding the national practice patterns and outcomes for this patient population is limited. Our objective is to describe the current practice patterns and survival outcomes for treatment strategies in cN+M0 UTUC patients.
Methods: 1,658 patients were identified in the National Cancer Database between 2004-2013 with cN+M0 UTUC. Patients were stratified into treatment groups. We compared baseline patient and tumor characteristics between groups, and completed a survival analysis using a multivariate Cox regression model accounting for all clinical variables associated with overall survival.
Results: There were 1,658 patients in the final study population. Pre-operative chemotherapy was the least utilized treatment group, comprising 6.8% of the overall population, and was associated with the highest median overall survival (36 months; Adjuvant chemotherapy: 21 mo.; Chemotherapy only: 14 mo.; Surgery without perioperative chemotherapy: 10 mo.; No treatment: 5 mo.). On multivariate analysis, pre-operative chemotherapy was associated with improved median overall survival as compared to the adjuvant chemotherapy group (HR 0.58 (0.38-0.87)). There was no statistically significant difference in survival between the chemotherapy only and surgery only groups. 34.6% of patients in the pre-operative chemotherapy group achieved pN0 as compared to 10.3% of those who underwent surgery as initial therapy. Only 5.3% of patients in the surgery only group were coded in NCDB as having a documented contraindication to receipt of multi-agent chemotherapy.
Conclusions: Pre-operative chemotherapy was the least utilized treatment strategy in the management of cN+M0 UTUC but was associated with the highest median overall survival, with a 15 month survival advantage over adjuvant chemotherapy. There was no difference in survival between the chemotherapy only and surgery only groups. Overall these results suggest that initial chemotherapy is appropriate in this population unless contraindicated.