Can we select patients with upper tract Urothelial Carcinoma suitable for neoadjuvant chemotherapy (NAC) from preoperative data?
BAUS ePoster online library. Abushamma F. Jun 27, 2018; 211381; P9-9
Mr. Faris Abushamma
Mr. Faris Abushamma
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Abstract
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Introduction: NAC is standard before cystectomy but not nephroureterectomy (NU) due to lack of evidence. Obstacles for NAC include risk of overtreatment based the limits of clinical staging and lack of biopsy; poor eGFR; and performance status (PS). Adjuvant chemotherapy, recently shown by the POUT study to be effective, may be compromised by post-operative reduction in eGFR but is only given for pathologically-proven invasive disease.

Methods: We examined the BAUS data from 2014-16 for NU patients with UTUC, comparing clinical to pathological stage, preoperative biopsy; renal function; and PS.

Results: Of 2217 with clinical and pathological staging, the percentage pT2+ increased with increasing clinical stage: cT1/a = 34.8%; cT2 = 67.8%; cT3 = 84.2%; and cT4 = 96.9%. Biopsy grading was reported in 1047 cases: G1 in 157; G2 in 477; G3 in 407 and G4 in 6. Combining G3 biopsy and cT2+ predicts pT2+ in 85%. eGFR was greater than 60 ml/min in 39.8%; 40-60 in 47.3%; and less than 40 in 12.9%. The median eGFR was 58. PS was 0 in 41.3%; 1 in 43.6%; 2 in 13.5%; and 4 in 0.1%.

Conclusions: NAC is feasible in terms of preoperative PS and eGFR. The accuracy of clinical staging alone is inadequate but is improved by G3 biopsy. Biopsies are currently performed in the minority of patients. Improvements in imaging and tissue sampling are needed to improve clinical staging accuracy.
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