SEER database analysis of survival impact of adjuvant chemotherapy after radical nephroureterectomy for upper tract urothelial carcinoma

Analysis of the SEER database found that from 2007 to 2020, use of adjuvant chemotherapy (AC) after radical nephroureterectomy (RNU) for pT2-4 upper tract urothelial carcinoma (UTUC) increased from 36.1% to 57.0% (estimated annual percent change 4.5%; p<0.001). The increase was from 28.8% tot 50.0% in TanyN0 patients (EAPC 7.8%; p<0.001) and from 50.0% tot 70.9% in TanyN1-2 patients (EAPC 2.3%; p=0.002). Within patients harboring TanyN1-2 stage, median cancer-specific mortality was 31 months with AC after RNU versus 16 months with RNU alone (p<0.0001) and AC independently predicted lower CSM (HR 0.64; p<0.001). In TanyN0 patients, AC use was not associated with CSM. The authors conclude that in RNU patients, AC use was associated with significantly lower CSM in lymph node-positive patients but not in lymph node-negative patients.