Survival Effect of Chemotherapy in Metastatic Upper Urinary Tract Urothelial Carcinoma

Background: Few data examined the potential survival benefit of chemotherapy (CHT) in the setting of metastatic upper urinary tract urothelial carcinoma (mUTUC). We hypothesized that a survival benefit might be associated with the use of CHT in nonsurgically treated primary mUTUC and tested this hypothesis within a large population-based cohort. Patients and Methods: Within the Surveillance, Epidemiology, and End Results database (2004-2014), we identified 539 patients with nonsurgically treated primary mUTUC. Inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier plots, as well as multivariable Cox regression models relying on IPTW and landmark analyses, were used to test the effect of CHT versus no CHT on overall mortality and cancer-specific mortality. Results: Of 539 patients with metastatic UTUC, 277 (51.4%) underwent CHT. In nonadjusted and IPTW-adjusted Kaplan-Meier plots, CHT was associated with better overall survival (9 vs. 2 months; P <.001 in both analyses). In multivariable Cox regression models, CHT administration independently predicted lower overall mortality before IPTW (hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.25-0.39; P <.001), as well as after IPTW adjustment (HR, 0.31; 95% CI, 0.25-0.38; P <.001). Similar results were recorded in landmark analyses (HR, 0.52; 95% CI, 0.38-0.70; P <.001). Finally, virtually the same results were obtained for cancer-specific mortality. Conclusions: Our analyses suggest a survival benefit after CHT in the setting of nonsurgically treated primary mUTUC. Chemotherapy (CHT) might offer a survival benefit in patients with nonsurgically treated metastatic primary upper tract urothelial carcinoma (mUTUC). We tested this hypothesis within 539 patients with mUTUC: 277 (51.4%) underwent CHT. In nonadjusted and fully adjusted Kaplan-Meier analyses, CHT was associated with better overall survival (9 vs. 2 months; P <.001 in both analyses). In multivariable Cox regression models, CHT administration independently predicted lower overall mortality (hazard ratio, 0.31; 95% confidence interval, 0.25-0.39; P <.001). Our analyses suggest a survival benefit of CHT in primary mUTUC