• Chih-Chin Yu, Chao-Hsiang Chang, Jen-Kai Fang, Steven K Huang, Wen-Hsin Tseng, Hsiang-Ying Lee, Hsin-Chih Yeh, I-Hsuan Alan Chen, Jen-Tai Lin, Pi-Che Chen, Ian-Seng Cheong, Thomas Y Hsueh, Yuan-Hong Jiang, Yu-Khun Lee, Wei-Chieh Chen, Shih-Hsiu Lo, Po-Hung Lin, Shian-Shiang Wang, Chao-Yuan Huang, Chia-Chang Wu, Jen-Shu Tseng, Shu-Yu Wu, and Yao-Chou Tsai.
• Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
• J Formos Med Assoc. 2023 Dec 1; 122 (12): 127412811274-1281.

PurposeThe purpose of this study is to evaluate the rates of pathological complete response (ypT0N0/X) and pathological response (ypT1N0/X or less) in patients with upper tract urothelial cancer who were treated with neo-adjuvant chemotherapy and to examine their impact on oncological outcomes.MethodsThis study is a multi-institutional retrospective analysis of patients with high-risk upper tract urothelial cancer who underwent neoadjuvant chemotherapy and radical nephroureterectomy between 2002 and 2021. Logistic regression analyses were used to investigate all clinical parameters for response after neoadjuvant chemotherapy. Cox proportional hazard models were performed to assess the effect of the response on the oncological outcomes.ResultsA total of 84 patients with UTUC who received neo-adjuvant chemotherapy were identified. Among them, 44 (52.4%) patients received cisplatin-based chemotherapy, and 22 (26.2%) patients had a carboplatin-based regimen. The pathological complete response rate was 11.6% (n = 10), and the pathological response rate was 42.9% (n = 36). Multifocal tumors or tumors larger than 3 cm significantly reduced the odds of pathological response. In the multivariable Cox proportional hazard model, pathological response was independently associated with better overall survival (HR 0.38, p = 0.024), cancer-specific survival (HR 0.24, p = 0.033), and recurrence-free survival (HR 0.17, p = 0.001), but it was not associated with bladder recurrence-free survival (HR 0.84, p = 0.69).ConclusionPathological response after neo-adjuvant chemotherapy and radical nephroureterectomy is strongly associated with patient survival and recurrence, and it might be a good surrogate for evaluating the efficacy of neo-adjuvant chemotherapy in the future.Copyright © 2023 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

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