A MULTICENTRE retrospective study from Japan has found that patients with advanced upper urinary tract urothelial carcinoma (UTUC) experience poorer outcomes with sequential therapy compared with those with bladder cancer (BC). The findings highlight the urgent need for more effective first-line treatments for UTUC, particularly in patients with synchronous disease.
The study analysed data from 517 patients with locally advanced or metastatic urothelial carcinoma treated between January 2020 and December 2021 across 54 Japanese institutions. Of these, 232 had UTUC and 285 had BC. Researchers compared clinical outcomes, response rates, and therapy patterns across first-, second-, and third-line treatments.
Upper Tract Urothelial Carcinoma Shows Worse Response Rates to Sequential Therapy
Results revealed that UTUC patients were more likely to present with poor renal function and metastases to the lung and liver. Multivariate analysis identified UTUC as an independent risk factor for overall survival. Progression-free survival (PFS) and response rates to first-line chemotherapy were significantly lower in UTUC than BC (PFS response 28.9% vs 38.2%). These differences persisted even after propensity score matching to account for baseline differences between groups.
Second-line therapy outcomes were also inferior for UTUC patients, although the proportion of patients transitioning to second-line therapy was similar between UTUC and BC groups. Notably, nearly half of UTUC patients (47.9%) could not proceed to third-line therapy, primarily due to disease progression or adverse events, highlighting the aggressive nature of UTUC.
The study concludes that UTUC carries a worse prognosis than bladder cancer across multiple lines of therapy, emphasising the importance of optimising initial treatment strategies. The authors advocate for the use of immune-combination therapies and other novel approaches as first-line treatment, particularly for patients with synchronous UTUC, to improve survival outcomes and reduce the likelihood of treatment attrition.
Optimising Care for High-Risk UTUC Patients
This research provides valuable insights into real-world treatment patterns and outcomes for urothelial carcinoma, reinforcing the need for tailored strategies for high-risk UTUC patients and the development of more effective therapeutic options to improve long-term survival.
Reference
Kanesaka M et al. Outcomes of sequential therapy for advanced upper tract urothelial cancer and bladder cancer. Sci Rep. 2025;15:41872.
