MP82-07: TRENDS IN PERIOPERATIVE MANAGEMENT AND OUTCOMES IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA FOLLOWING RADICAL NEPHROURETECTOMY AT MEMORIAL SLOAN KETTERING CANCER CENTER

Nathan C. Wong, Melissa Assel, Andrew Tracey, Ricardo G. Alvim, Nima Almassi, Nirmish Singla, Gregory Chesnut, Tim N. Clinton, Daniel Sjoberg, Bernard H. Bochner, Guido Dalbagni, S. Machele Donat, Harry W. Herr, Eugene Cha, Timothy Donahue, Eugene Pietzak, Hikmat Al-Ahmadie, Gopa Iyer, Min Yuen Teo, Jonathan E. Rosenberg, Dean F. Bajorin, Jonathan A. Coleman

Introduction: Upper tract urothelial carcinoma (UTUC) is a rare disease associated with poor prognosis. Increasing recent attention has been paid to surgical care and multidisciplinary management with limited data available on strategy shift in and associated outcomes. We evaluated surgical trends and perioperative management of patients who underwent radical nephroureterectomy (RNU) for UTUC over a 24-year period to estimate the impact of these strategy shifts on outcomes.

Methods: Between 1995 and 2018, 760 patients with UTUC underwent RNU – 15 had multiple RNU and only the first procedure was used for analysis. We estimated the association between date of surgery and various outcomes using generalize additive models to allow for nonlinearity of the relationships with the appropriate link function. Generalized additive cox proportional hazards models were used to estimate the association between date of surgery and cancer-specific survival and from this model, 2-year rates were generated.

Results: Over the study period, use of pre-operative diagnostic endoscopic biopsies increased from 12% to 72% coinciding with an increased proportion of RNU performed for high grade UTUC from 55% to 91%. Rate of open procedures declined from 100% to 54% as utilization of minimally invasive approaches increased (Figure 1A). Laparoscopy peaked in 2008 and was subsequently replaced by robotic-assisted surgery. Mean lymph node yield increased with more retroperitoneal lymph node dissections performed (Figure 1B). Utilization of neoadjuvant chemotherapy also increased with a contemporary utilization rate of 31%, coinciding with an increase in pT0 rate from 2% to 9% (Figure 1C).  Despite the increase proportion of high-grade UTUC, 2-year cancer specific survival probability improved from 76% to 87% (Figure 1D).

Conclusions: Over the past 2 decades at our institution, increases were seen in NAC, node dissection and minimally invasive surgical approaches that coincided with a shift toward management of higher risk patients undergoing RNU and improved oncologic outcomes. Whether there exists a causal relationship between changes to clinical practice and patient outcomes needs to be investigated in future studies. Source of

Funding: This research was supported by the Sidney Kimmel Center for Prostate and Urologic Cancers and funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.