Adjuvant chemotherapy after radical nephroureterectomy (RNU) may improve overall survival compared with observation alone after surgery among patients with pT3/T4 and/or pN+ upper tract urothelial carcinoma (UTUC), according to an observational study published in the Journal of Clinical Oncology.1

There is limited evidence to support the use of adjuvant chemotherapy after RNU for UTUC; researchers therefore evaluated whether this treatment is associated with an overall survival benefit among patients with locally advanced and/or positive regional lymph node disease.

Investigators analyzed data from 3253 patients with pT3/T4 and/or pN+ UTUC, of which 23.42% and 76.58% receive adjuvant chemotherapy and observation, respectively.

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Median overall survival was significantly longer with adjuvant chemotherapy vs observation (P < .001). Patients who received adjuvant chemotherapy had a median survival of 47.41 months compared with 35.78 months with observation; the 5-year overall survival rates were 43.90% and 35.85%, respectively.

Receipt of adjuvant chemotherapy was associated with a significant 23% reduced risk of death compared with observation (hazard ratio, 0.77; 95% CI, 0.68-0.88; P < .001).

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Researchers observed consistent benefit across all subgroups evaluated and did not identify significant heterogeneity of treatment effect.


  1. Seisen T, Krasnow RE, Bellmunt J, et al. Effectiveness of adjuvant chemotherapy after radical nephroureterectomy for locally advanced and/or positive regional lymph node upper tract urothelial carcinoma. J Clin Oncol. 2017 Jan 3. doi: 10.1200/JCO.2016.69.4141 [Epub ahead of print]