Sheybaee Moghaddam Farshad, Sayyid Rashid K, Ghoreifi Alireza, Franco Antonio, Wu Zhenjie, Wang Linhui, Antonelli Alessandro, Ditonno Francesco, Abdollah Firas, Finati Marco, Simone Giuseppe, Tuderti Gabriele, Helstrom Emma, Correa Andres F, De Cobelli Ottavio, Ferro Matteo, Porpiglia Francesco, Amparore Daniele, Tufano Antonio, Perdonà Sisto, Brönimann Stephan, Singla Nirmish, Meagher Margaret F, Derweesh Ithaar H, Mendiola Dinno F, Gonzalgo Mark L, Ben-David Reuben, Mehrazin Reza, Moon Sol C, Rais-Bahrami Soroush, Yong Courtney, Sundaram Chandru P, Bhanvadia Raj, Margulis Vitaly, Autorino Riccardo, Djaladat Hooman
Norris Comprehensive Cancer Center, Department of Urology, University of Southern California, Los Angeles, CA.
Department of Urology, Rush University, Chicago, IL.
Urol Oncol. 2025 Jul;43(7):441.e19-441.e27. doi: 10.1016/j.urolonc.2025.03.001. Epub 2025 Mar 24.
To evaluate survival outcomes and recurrence patterns by pathologic nodal status in upper tract urothelial carcinoma (UTUC) patients receiving neoadjuvant chemotherapy (NAC) prior to radical nephroureterectomy (RNU) and lymph node dissection (LND).
Using the international ROBUUST 2.0 database, a retrospective analysis of UTUC patients who underwent robotic/laparoscopic RNU+LND±NAC was performed. Patients were stratified by NAC and pathologic nodal status into pN0, ypN0, pN+, and ypN+ subgroups. Overall (OS), metastasis-free (MFS), and urothelial recurrence-free survivals (RFS) were compared using Kaplan-Meier curves and multivariable Cox regression modeling.
The cohort included 883 patients (15% received NAC). 212 (24%) patients had (y)pN+ disease. Median follow-up was 19 months. Compared to pN+ patients, ypN+ patients had significantly worse 1- (64% vs. 72%), 3- (40% vs. 54%), and 5-year (20% vs. 31%) OS rates. Node-negative patients had similar OS, irrespective of NAC treatment (1-year: 94%; 3-year: 77%-82%). At 1 year, all ypN+ patients had metastases, while 13% of pN+ patients remained metastasis-free. Among ypN+ patients, 89% experienced nodal/regional or distant metastases as the site of initial recurrence, compared to 39% of pN+ patients. Initial nodal/regional or distant metastases occurred in 42% and 18% of ypN0 and pN0 patients, respectively.
ypN+ patients have worse survival compared to pN+ patients. Recurrence patterns differ by nodal and NAC status, with ypN+ patients having a significantly higher incidence of nodal/regional or distant metastases as the initial site of recurrence. These survival outcomes and recurrence patterns differences may have important surveillance and treatment implications.
评估接受新辅助化疗（NAC）后行根治性肾输尿管切除术（RNU）及淋巴结清扫术（LND）的上尿路尿路上皮癌（UTUC）患者按病理淋巴结状态分类的生存结果及复发模式。
利用国际ROBUUST 2.0数据库，对接受机器人/腹腔镜RNU+LND±NAC的UTUC患者进行回顾性分析。患者按NAC及病理淋巴结状态分层为pN0、ypN0、pN+和ypN+亚组。采用Kaplan-Meier曲线和多变量Cox回归模型比较总生存期（OS）、无转移生存期（MFS）和无尿路上皮复发生存期（RFS）。
该队列包括883例患者（15%接受NAC）。212例（24%）患者有（y）pN+疾病。中位随访时间为19个月。与pN+患者相比，ypN+患者的1年（64%对72%）、3年（40%对54%）和5年（20%对31%）总生存率显著更差。淋巴结阴性患者的总生存期相似，无论是否接受NAC治疗（1年：94%；3年：77%-82%）。1年时，所有ypN+患者均有转移，而13%的pN+患者仍无转移。在ypN+患者中，89%以淋巴结/区域或远处转移作为初始复发部位，相比之下，pN+患者为39%。ypN0和pN0患者分别有42%和18%发生初始淋巴结/区域或远处转移。
与pN+患者相比，ypN+患者的生存率更差。复发模式因淋巴结及NAC状态而异，ypN+患者以淋巴结/区域或远处转移作为初始复发部位的发生率显著更高。这些生存结果和复发模式差异可能对监测和治疗具有重要意义。
