Impact of adjuvant chemotherapy on renal impairment patients following radical nephroureterectomy in upper tract urothelial carcinoma: a multicenter retrospective study

Abstract To evaluate the impact of adjuvant platinum-based chemotherapy (AC) on oncological outcomes in high-risk upper tract urothelial carcinoma (UTUC) patients with postoperative renal impairment following radical nephroureterectomy (RNU). Among 1050 patients who underwent RNU at 10 affiliated hospitals, we retrospectively evaluated 136 UTUC patients with ≥pT3 and/or node-positive UTUC and postoperative eGFR 30–59 mL/min/1.73 m². Patients were divided into an AC group ( n = 52), who received gemcitabine plus cisplatin (GC) or carboplatin (GCa), and a non-AC group ( n = 84). Oncological outcomes, including disease-free survival (DFS) and overall survival (OS), were evaluated using propensity score matching (PSM). In the AC group, DFS and OS were also compared between GC ( n = 33) and GCa ( n = 19). The median follow-up was 48.6 months. Before PSM, three-year DFS was 61.5% versus 27.2% in the AC and non-AC groups, respectively ( p < 0.0001), whereas three-year OS was 76.8% versus 68.6% ( p = 0.16). After PSM, AC remained associated with longer DFS (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.18–0.70; p = 0.0019), while no statistically significant difference in OS was observed (HR, 0.83; 95% CI, 0.34–2.01; p = 0.676). Within the AC group, cisplatin dosing in the GC regimen was determined according to postoperative renal function. No statistically significant differences in DFS or OS were observed between patients treated with GC and GCa. Platinum-based AC was associated with improved DFS in selected high-risk UTUC patients despite postoperative renal impairment, supporting consideration of GC or GCa according to renal function.