In patients (pts) with upper tract urothelial carcinoma (UTUC) the benefit of adjuvant chemotherapy (ACT) after radical nephroureterectomy (RNU) is debated. We aimed to analyze the benefit of ACT vs observation (Obs) in an international study.
Data from 15 centers was collected, totalling 1,544 pts, treated between 2000 and 2015. Criteria for pt selection were: UTUC diagnosis, pT2-4N0/x and/or pN+ stage undergoing RNU. The standardized differences (SD) approach was used to compare subgroup characteristics. Overall survival (OS) was the primary endpoint. The adopted propensity scores (PS) techniques included 1:1 PS matching and inverse probability of treatment weighting (IPTW). Additionally, the IPTW analysis was performed with the inclusion of the covariates, i.e. with doubly robust estimation (DREP). 6-month landmark analysis (LA) was also performed.
A total of 312 pts received ACT and 1,232 observations. Despite differences between the two groups, SD was generally
ACT does not improve OS compared to Obs in pT2-4 and/or pN+ UTUC. These findings contribute to the uncertainties regarding ACT in UTUC and further support the need for dedicated prospective trials in UTUC, new more potent therapies, and enhanced pt selection criteria.
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All authors have declared no conflicts of interest.