Direct head-to-head comparison between neoadjuvant and adjuvant chemotherapy in upper tract urothelial carcinoma: A systematic review and meta-analysis.

This article focuses on a meta-analysis comparing neoadjuvant chemotherapy (NAC) versus adjuvant chemotherapy (AC) in patients with upper tract urothelial carcinoma (UTUC). Analyzing five retrospective cohort studies involving 1,938 patients, the findings indicate that NAC is associated with improved pathological outcomes, including higher rates of pathological downstaging and lower risk of positive surgical margins, as well as reduced disease recurrence and better short-term cancer-specific and recurrence-free survival compared to AC. However, no significant differences were observed in overall survival between the two approaches. The analysis highlights the clinical relevance of NAC in preserving renal function prior to radical nephroureterectomy, which may enhance eligibility for cisplatin-based chemotherapy, though direct renal function data were lacking. The authors emphasize the need for prospective randomized trials incorporating biomarker-guided strategies and renal function assessment to optimize perioperative chemotherapy sequencing in UTUC.