#1118

Optimizing Perioperative Chemotherapy in Upper Tract Urothelial Carcinoma: A Real-World TriNetx Analysis of Neoadjuvant vs. Adjuvant Approaches

Y. HUANG¹, G. LAI¹, C. YANG¹, S. WANG¹, J. LI¹

¹VGHTC, Urology, TAICHUNG, Taiwan

Introduction:

Upper tract urothelial carcinoma (UTUC) is a rare but aggressive malignancy with high recurrence risk. While radical nephroureterectomy (RNU) is the standard treatment, the role of perioperative chemotherapy remains debated. The POUT trial supports adjuvant chemotherapy (AC), whereas evidence for neoadjuvant chemotherapy (NAC) comes mainly from retrospective studies. To further assess chemotherapy sequencing, we utilized TriNetx, a real-world database integrating multi-institutional electronic health records, to compare NAC and AC outcomes in UTUC patients undergoing RNU.

Material and methods:

Using the TriNetx database, we conducted a retrospective study of UTUC patients receiving either neoadjuvant cisplatin/carboplatin (NAC) or adjuvant cisplatin/carboplatin (AC). After propensity score matching, Kaplan-Meier analysis was performed to compare overall survival (OS) between the cohorts.

Results:

After applying inclusion criteria and propensity score matching, a total of 546 patients were included in each cohort. The median OS was 2,764 days in the NAC group, compared to 2,012 days in the AC group, highlighting the potential survival benefit of neoadjuvant chemotherapy. Kaplan-Meier analysis further confirmed a significant survival advantage for the NAC group over the AC group (p = 0.0424, HR = 0.829, 95% CI: 0.692–0.994).