Real-World Outcomes of First-Line Systematic Treatment in Locally Advanced or Metastatic Upper Urinary Tract...

To investigate the impact of renal impairment (RI) on the efficacy of first-line chemotherapy in patients with locally advanced or metastatic upper tract urothelial carcinoma (la/mUTUC).

This multicenter retrospective study evaluated 300 patients with la/mUTUC who received GEM/CDDP or GEM/CBDCA as first-line chemotherapy. RI was defined as eGFR < 45 mL/min/1.73 m² and used to categorize patients into RI and without-RI groups. Objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were analyzed. Multivariable Cox proportional hazard analysis was conducted to assess risk factors for PFS and OS. In the RI group, oncologic outcomes were compared between GEM/CDDP and GEM/CBDCA.

Overall, 130 patients (43%) had RI, and 170 (57%) did not. During a median follow-up of 32 months, 188 patients (63%) died: 74 patients (56%) in the RI group and 114 (67%) in the without-RI group. Among 288 evaluable patients, the ORR was 34% in the RI group and 45% in the without-RI group (p = 0.072). The median PFS of the RI and without-RI groups was 5.6 and 4.8 months, respectively (p = 0.322), and the median OS was 16.9 and 14.5 months, respectively (p = 0.074). Among the RI group, no significant differences were observed between GEM/CDDP and GEM/CBDCA in PFS (6.4 vs. 4.2 months, p = 0.113) or OS (21.4 vs. 15.2 months, p = 0.142).

In la/mUTUC, oncologic outcomes were comparable between patients with and without RI. In the RI group, responses to GEM/CDDP and GEM/CBDCA did not differ.