Presentation Authors: Nirmish Singla*, Alana Christie, Timothy Clinton, Yuval Freifeld, Rashed Ghandour, Solomon Woldu, Dallas, TX, Firas Petros, Wei Qiao, Houston, TX, Haley Robyak, Hershey, PA, Aditya Bagrodia, Yair Lotan, Dallas, TX, Jay Raman, Hershey, PA, Surena Matin, Houston, TX, Vitaly Margulis, Dallas, TX
Introduction: Oncologic benefits of neoadjuvant chemotherapy (NAC) for upper tract urothelial carcinoma (UTUC) have been described. The prognostic significance of pT0-1 stage in patients receiving NAC versus chemotherapy-naive patients remains unclear. Therefore, among patients found to have stage pT0-1 (including pTis) after undergoing extirpative surgery for high-grade UTUC, we sought to 1) compare clinicopathologic characteristics between ypT0-1 and pT0-1 patients and 2) evaluate whether receipt of NAC influences oncologic outcomes in these patients.
Methods: Clinicopathologic data from 647 patients who underwent extirpative surgery for UTUC among three institutions from 1993-2016 were compiled. Patients with low or unknown grade disease or muscle invasion were excluded. Pathologic data and oncologic outcomes were compared between pT0-1 and ypT0-1 patients. Kaplan-Meier analysis was used to compare overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), and intravesical RFS (IVRFS) among patients. Cox regression was performed to identify predictors of these oncologic endpoints.
Results: 234 patients with high-grade non-muscle-invasive disease were included for analysis (43 ypT0-1 and 191 pT0-1). ypT0 was achieved in 2 patients. Lymphovascular invasion was more prevalent among ypT0-1 patients (15.4% vs. 4.3%, p=0.022). Preoperative radiographic cT3 disease was nearly twice as prevalent in ypT0-1 than in pT0-1 patients (7.1% vs. 3.6%, p=0.390), though statistical significance was not achieved. Clinicopathologic characteristics were otherwise similar between groups. On Kaplan-Meier analyses (Figure), OS (p=0.055), CSS (p=0.152), RFS (p=0.148), and IVRFS (p=0.645) were comparable between ypT0-1 and pT0-1 patients. Receipt of NAC was not a significant predictor for any of these endpoints on Cox regression.
Conclusions: Patients with ypT0-1 stage disease exhibit similar oncologic outcomes as those with pT0-1 stage disease in high-grade UTUC. Our results suggest that tumors successfully downstaged to non-muscle-invasive disease using NAC resemble the behavior of those that are non-muscle-invasive without NAC. Thus, pathologic downstaging from NAC may potentially serve as a surrogate for oncologic endpoints.