Risk-adapted scoring model to identify candidates benefiting from adjuvant chemotherapy after radical nephroureterectomy for localized upper urinary tract urothelial carcinoma: A multicenter study

• Published in: Investigative and clinical urology Vol. 66; no. 2; pp. 114 - 123
• Main Authors: Sou, Sung Jun, Ku, Ja Yoon, Kim, Kyung Hwan, Seo, Won Ik, Ha, Hong Koo, Gu, Hui Mo, Hwang, Eu Chang, Park, Young Joo, Lee, Chan Ho
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Urological Association 01.03.2025; Korean Urological Association; 대한비뇨의학회
• Subjects: adjuvant; Aged; Aged, 80 and over; Carcinoma, Transitional Cell - drug therapy; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; chemotherapy; Chemotherapy, Adjuvant; Female; Humans; Kidney Neoplasms - drug therapy; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; nephroureterectomy; Nephroureterectomy - methods; Original; renal pelvis; Retrospective Studies; Risk Assessment; risk factor scores; ureteral neoplasms; Ureteral Neoplasms - drug therapy; Ureteral Neoplasms - pathology; Ureteral Neoplasms - surgery; 비뇨기과학; Ureteral neoplasms; Nephroureterectomy; Chemotherapy, adjuvant; Renal pelvis; Risk factor scores
• ISSN: 2466-0493; 2466-054X; 2466-054X
• DOI: 10.4111/icu.20240323

Adjuvant chemotherapy (AC) is recommended for muscle-invasive or lymph node-positive upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). However, disease recurrences are frequently observed in pT1 disease, and AC may increase the risk of overtreatment in pT2 UTUC patients. This study aimed to validate a risk-adapted scoring model for selecting UTUC patients with ≤pT2 disease who would benefit from AC. We retrospectively analyzed 443 ≤pT2 UTUC patients who underwent RNU. A risk-adapted scoring model was applied, categorizing patients into low- or high-risk groups. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed according to risk group. Overall, 355 patients (80.1%) and 88 patients (19.9%) were categorized into the low- and high-risk groups, respectively, with the latter having higher pathological stages, concurrent carcinoma , and synchronous bladder tumors. Disease recurrence occurred in 45 patients (10.2%), among whom 19 (5.4%) and 26 (29.5%) belonged to the low- and high-risk groups, respectively (p<0.001). High-risk patients had significantly shorter RFS (64.3% vs. 93.6% at 60 months; hazard ratio [HR] 13.66; p<0.001) and worse CSS (80.7% vs. 91.5% at 60 months; HR 4.25; p=0.002). Multivariate analysis confirmed that pT2 stage and the high-risk group were independent predictors of recurrence and cancer-specific death (p<0.001). Decision curve analysis for RFS showed larger net benefits with our model than with the T stage model. The risk-adapted scoring model effectively predicts recurrence and identifies optimal candidates for AC post RNU in non-metastatic UTUC.