Can Imaging Response following Neoadjuvant Chemotherapy in Upper Tract Urothelial Cancer be a Surrogate for Pathologic Response?

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Pathological response following neoadjuvant chemotherapy (NAC) has been shown to be an excellent surrogate for survival in bladder cancer. In upper tract urothelial cancer (UTUC), unlike bladder, preoperative endoscopic and pathologic assessment of response is difficult. The aim of this study is to determine whether imaging response following NAC predicted the final pathologic stage and outcomes following radical nephroureterectomy (NU).


We identified all radical nephroureterectomies performed at our institution from January 1995 until July 2017. All cytology and biopsy proven, ≥cT2anyNM0 high grade UTUC patients who underwent NAC with cisplatinum based chemotherapy prior to RNU were analyzed. Evaluation with CT/MR urography was available both before and after NAC. Radiological response rate (RRR) was estimated using the RECIST criteria and pathologic response was defined as