Neoadjuvant chemotherapy prior to radical nephroureterectomy: Survival outcomes and recurrence patterns by pathologic node status

Farshad Sheybaee Moghaddam; Rashid K. Sayyid; Alireza Ghoreifi; Antonio Franco; Zhenjie Wu; Linhui Wang; Alessandro Antonelli; Francesco Ditonno; Firas Abdollah; Marco Finati; Giuseppe Simone; Gabriele Tuderti; Emma Helstrom; Andres F. Correa; Ottavio De Cobelli; Matteo Ferro; Francesco Porpiglia; Daniele Amparore; Antonio Tufano; Sisto Perdonà; Stephan Brönimann; Nirmish Singla; Margaret F. Meagher; Ithaar H. Derweesh; Dinno F. Mendiola; Mark L. Gonzalgo; Reuben Ben-David; Reza Mehrazin; Sol C. Moon; Soroush Rais-Bahrami; Courtney Yong; Chandru P. Sundaram; Raj Bhanvadia; Vitaly Margulis; Riccardo Autorino; Hooman Djaladat

doi:10.1016/j.urolonc.2025.03.001

Neoadjuvant chemotherapy prior to radical nephroureterectomy: Survival outcomes and recurrence patterns by pathologic node status

Farshad Sheybaee Moghaddam
, Rashid K. Sayyid
, Alireza Ghoreifi
, Antonio Franco
, Zhenjie Wu
, Linhui Wang
, Alessandro Antonelli
, Francesco Ditonno
, Firas Abdollah
, Marco Finati
, Giuseppe Simone
, Gabriele Tuderti
, Emma Helstrom
, Andres F. Correa
, Ottavio De Cobelli
, Matteo Ferro
, Francesco Porpiglia
, Daniele Amparore
, Antonio Tufano
, Sisto Perdonà

Stephan Brönimann, Nirmish Singla, Margaret F. Meagher, Ithaar H. Derweesh, Dinno F. Mendiola, Mark L. Gonzalgo, Reuben Ben-David, Reza Mehrazin, Sol C. Moon, Soroush Rais-Bahrami, Courtney Yong, Chandru P. Sundaram, Raj Bhanvadia, Vitaly Margulis, Riccardo Autorino, Hooman Djaladat

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Purpose: 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). Materials and Methods: 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. Results: 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. Conclusion: 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.

Original language	English
Pages (from-to)	441.e19-441.e27
Journal	Urologic Oncology: Seminars and Original Investigations
Volume	43
Issue number	7
DOIs	https://doi.org/10.1016/j.urolonc.2025.03.001
State	Published - Jul 2025

Keywords

Drug therapy
Laparoscopy
Nephroureterectomy
Survival
Ureteral neoplasm

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10.1016/j.urolonc.2025.03.001

Cite this

Sheybaee Moghaddam, F., Sayyid, R. K., Ghoreifi, A., Franco, A., Wu, Z., Wang, L., Antonelli, A., Ditonno, F., Abdollah, F., Finati, M., Simone, G., Tuderti, G., Helstrom, E., Correa, A. F., De Cobelli, O., Ferro, M., Porpiglia, F., Amparore, D., Tufano, A., ... Djaladat, H. (2025). Neoadjuvant chemotherapy prior to radical nephroureterectomy: Survival outcomes and recurrence patterns by pathologic node status. Urologic Oncology: Seminars and Original Investigations, 43(7), 441.e19-441.e27. https://doi.org/10.1016/j.urolonc.2025.03.001

@article{6551c2eff2b34a7c96c1a9c41ec60e69,

title = "Neoadjuvant chemotherapy prior to radical nephroureterectomy: Survival outcomes and recurrence patterns by pathologic node status",

abstract = "Purpose: 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). Materials and Methods: 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. Results: 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. Conclusion: 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.",

keywords = "Drug therapy, Laparoscopy, Nephroureterectomy, Survival, Ureteral neoplasm",

author = "\{Sheybaee Moghaddam\}, Farshad and Sayyid, \{Rashid K.\} and Alireza Ghoreifi and Antonio Franco and Zhenjie Wu and Linhui Wang and Alessandro Antonelli and Francesco Ditonno and Firas Abdollah and Marco Finati and Giuseppe Simone and Gabriele Tuderti and Emma Helstrom and Correa, \{Andres F.\} and \{De Cobelli\}, Ottavio and Matteo Ferro and Francesco Porpiglia and Daniele Amparore and Antonio Tufano and Sisto Perdon{\`a} and Stephan Br{\"o}nimann and Nirmish Singla and Meagher, \{Margaret F.\} and Derweesh, \{Ithaar H.\} and Mendiola, \{Dinno F.\} and Gonzalgo, \{Mark L.\} and Reuben Ben-David and Reza Mehrazin and Moon, \{Sol C.\} and Soroush Rais-Bahrami and Courtney Yong and Sundaram, \{Chandru P.\} and Raj Bhanvadia and Vitaly Margulis and Riccardo Autorino and Hooman Djaladat",

note = "Publisher Copyright: {\textcopyright} 2025 Elsevier Inc.",

year = "2025",

month = jul,

doi = "10.1016/j.urolonc.2025.03.001",

language = "English",

volume = "43",

pages = "441.e19--441.e27",

journal = "Urologic Oncology: Seminars and Original Investigations",

issn = "1078-1439",

publisher = "Elsevier Inc.",

number = "7",

}

Sheybaee Moghaddam, F, Sayyid, RK, Ghoreifi, A, Franco, A, Wu, Z, Wang, L, Antonelli, A, Ditonno, F, Abdollah, F, Finati, M, Simone, G, Tuderti, G, Helstrom, E, Correa, AF, De Cobelli, O, Ferro, M, Porpiglia, F, Amparore, D, Tufano, A, Perdonà, S, Brönimann, S, Singla, N, Meagher, MF, Derweesh, IH, Mendiola, DF, Gonzalgo, ML, Ben-David, R, Mehrazin, R, Moon, SC, Rais-Bahrami, S, Yong, C, Sundaram, CP, Bhanvadia, R, Margulis, V, Autorino, R & Djaladat, H 2025, 'Neoadjuvant chemotherapy prior to radical nephroureterectomy: Survival outcomes and recurrence patterns by pathologic node status', Urologic Oncology: Seminars and Original Investigations, vol. 43, no. 7, pp. 441.e19-441.e27. https://doi.org/10.1016/j.urolonc.2025.03.001

Neoadjuvant chemotherapy prior to radical nephroureterectomy: Survival outcomes and recurrence patterns by pathologic node status. / Sheybaee Moghaddam, Farshad; Sayyid, Rashid K.; Ghoreifi, Alireza et al.
In: Urologic Oncology: Seminars and Original Investigations, Vol. 43, No. 7, 07.2025, p. 441.e19-441.e27.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Neoadjuvant chemotherapy prior to radical nephroureterectomy

T2 - Survival outcomes and recurrence patterns by pathologic node status

AU - Sheybaee Moghaddam, Farshad

AU - Sayyid, Rashid K.

AU - Ghoreifi, Alireza

AU - Franco, Antonio

AU - Wu, Zhenjie

AU - Wang, Linhui

AU - Antonelli, Alessandro

AU - Ditonno, Francesco

AU - Abdollah, Firas

AU - Finati, Marco

AU - Simone, Giuseppe

AU - Tuderti, Gabriele

AU - Helstrom, Emma

AU - Correa, Andres F.

AU - De Cobelli, Ottavio

AU - Ferro, Matteo

AU - Porpiglia, Francesco

AU - Amparore, Daniele

AU - Tufano, Antonio

AU - Perdonà, Sisto

AU - Brönimann, Stephan

AU - Singla, Nirmish

AU - Meagher, Margaret F.

AU - Derweesh, Ithaar H.

AU - Mendiola, Dinno F.

AU - Gonzalgo, Mark L.

AU - Ben-David, Reuben

AU - Mehrazin, Reza

AU - Moon, Sol C.

AU - Rais-Bahrami, Soroush

AU - Yong, Courtney

AU - Sundaram, Chandru P.

AU - Bhanvadia, Raj

AU - Margulis, Vitaly

AU - Autorino, Riccardo

AU - Djaladat, Hooman

PY - 2025/7

Y1 - 2025/7

N2 - Purpose: 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). Materials and Methods: 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. Results: 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. Conclusion: 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.

AB - Purpose: 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). Materials and Methods: 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. Results: 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. Conclusion: 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.

KW - Drug therapy

KW - Laparoscopy

KW - Nephroureterectomy

KW - Survival

KW - Ureteral neoplasm

UR - https://www.scopus.com/pages/publications/105001022636

U2 - 10.1016/j.urolonc.2025.03.001

DO - 10.1016/j.urolonc.2025.03.001

M3 - Article

AN - SCOPUS:105001022636

SN - 1078-1439

VL - 43

SP - 441.e19-441.e27

JO - Urologic Oncology: Seminars and Original Investigations

JF - Urologic Oncology: Seminars and Original Investigations

IS - 7

ER -

Neoadjuvant chemotherapy prior to radical nephroureterectomy: Survival outcomes and recurrence patterns by pathologic node status

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Keywords

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