Outcomes of sequential therapy for advanced upper tract urothelial cancer and bladder cancer

This multicenter retrospective study compared clinical outcomes and sequential therapy patterns between upper urinary tract urothelial carcinoma (UTUC) and bladder cancer (BC). Data from 517 patients with locally advanced/metastatic urothelial carcinoma diagnosed between January 2020 and December 2021 at 54 Japanese institutions were analysed (232 UTUC, 285 BC). UTUC patients were more likely to have poor renal function and metastases to the lung, liver. Multivariate analysis identified UTUC as an independent risk factor for overall survival (OS). UTUC showed significantly shorter progression-free survival (PFS) and lower response rates to first-line chemotherapy than BC (28.9% vs. 38.2%). These findings persisted after propensity score matching. OS following second-line therapy was also inferior in UTUC, although the rate of transition to second-line therapy was similar between groups. However, a higher proportion of UTUC patients (47.9%) could not proceed to third-line therapy, mainly due to disease progression or adverse events. Overall, UTUC was associated with a worse prognosis than BC. These results highlight the urgent need for more effective first-line treatments, such as immune-combination therapies, particularly in synchronous UTUC cases. ・Keywords: bladder cancer, chemotherapy, prognosis, sequential therapy, upper urinary tract urothelial cancer.