Real-world perioperative systemic treatment patterns and postoperative mortality in patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy in Japan: WAKKA-UTUC study
- 1Department of Urology, Graduate School of Medicine, University of the Ryukyus, 1076 Kiyuna, Ginowan, Okinawa 901-2720 Japan
- 2Medical Department, AstraZeneca K.K., Tokyo, Japan
- 3Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan
Abstract
Background: To characterize the longitudinal changes in perioperative systemic treatment patterns and postoperative mortality among Japanese patients with stage II–IV upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU).
Methods: This retrospective observational study used a nationwide Japanese database to evaluate neoadjuvant chemotherapy (NAC) and adjuvant therapy (AT) before and after RNU. Treatment patterns, specific regimens, and 30- and 90-day postoperative mortality were analyzed descriptively across three periods: 2013–2017, 2018–2021, and 2022–2024.
Results: Among 6,165 patients included in the study, the use of AT without prior NAC increased from 25.7% in 2013–2017 to 30.0% in 2022–2024, and the proportion of patients who received any NAC increased from 9.8% to 17.1%, respectively. By 2022–2024, gemcitabine plus carboplatin emerged as the most widely used regimen for NAC and AT (6.5% and 15.2% of the overall study population during this period [n = 1,482], respectively). Adjuvant nivolumab was administered to 142 patients (9.6% of all patients undergoing RNU in 2022–2024), but most (n = 84) had not received prior NAC. Postoperative mortality remained stable across the study periods (30-day mortality: 0.0%–0.5%; 90-day mortality: 0.3%–2.0%), with no increase in mortality among patients who received NAC.
Conclusions: The use of perioperative systemic therapy for UTUC in Japan increased over the study period, with growing adoption of NAC, AT, and adjuvant nivolumab. Postoperative mortality remained stable, showing no notable association with NAC.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10147-026-03198-6.
Related
- Perioperative Antifibrotic Treatment and Early Postoperative Outcomes in Patients With Idiopathic Pulmonary Fibrosis Undergoing Lung Cancer Surgery: A Systematic Review and Meta‐Analysis
- Development and Validation of a Perioperative Risk Update Model for Postoperative Delirium in Patients Aged ≥ 80 Years Undergoing Hip Fracture Surgery: A Retrospective Cohort Study
- Impact of perioperative physical exercise on postoperative pulmonary complications in patients undergoing cardiac surgery: a systematic review and meta-analysis
- Effect of perioperative opioid-sparing multimodal analgesia on early postoperative sleep disturbance in adults undergoing elective non-cardiac, non-obstetric surgery under general anaesthesia: protocol for a systematic review and meta-analysis
- Effects of Mindfulness-Based Stress Reduction Combined With Perioperative Refined Nursing on Postoperative Sleep Disturbances, Anxiety, and Depression in Patients Undergoing Coronary Artery Bypass Grafting
BibTeX
@article{inokuchi2026realworld,
title = {{Real-world perioperative systemic treatment patterns and postoperative mortality in patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy in Japan: WAKKA-UTUC study}},
author = {Junichi Inokuchi and Jumpei Tokumaru and Daisuke Kawai and Ryotaro Ide and Hiroshi Komazaki and Hiroshi Kitagawa and Eiji Kikuchi},
journal = {International Journal of Clinical Oncology},
year = {2026},
month = sep,
doi = {10.1007/s10147-026-03198-6},
url = {https://doi.org/10.1007/s10147-026-03198-6},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Real-world perioperative systemic treatment patterns and postoperative mortality in patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy in Japan: WAKKA-UTUC study
AU - Junichi Inokuchi
AU - Jumpei Tokumaru
AU - Daisuke Kawai
AU - Ryotaro Ide
AU - Hiroshi Komazaki
AU - Hiroshi Kitagawa
AU - Eiji Kikuchi
PY - 2026
DA - 2026/09/19
JO - International Journal of Clinical Oncology
DO - 10.1007/s10147-026-03198-6
UR - https://doi.org/10.1007/s10147-026-03198-6
AB - Background: To characterize the longitudinal changes in perioperative systemic treatment patterns and postoperative mortality among Japanese patients with stage II–IV upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU). Methods: This retrospective observational study used a nationwide Japanese database to evaluate neoadjuvant chemotherapy (NAC) and adjuvant therapy (AT) before and after RNU. Treatment patterns, specific regimens, and 30- and 90-day postoperative mortality were analyzed descriptively across three periods: 2013–2017, 2018–2021, and 2022–2024. Results: Among 6,165 patients included in the study, the use of AT without prior NAC increased from 25.7% in 2013–2017 to 30.0% in 2022–2024, and the proportion of patients who received any NAC increased from 9.8% to 17.1%, respectively. By 2022–2024, gemcitabine plus carboplatin emerged as the most widely used regimen for NAC and AT (6.5% and 15.2% of the overall study population during this period [n = 1,482], respectively). Adjuvant nivolumab was administered to 142 patients (9.6% of all patients undergoing RNU in 2022–2024), but most (n = 84) had not received prior NAC. Postoperative mortality remained stable across the study periods (30-day mortality: 0.0%–0.5%; 90-day mortality: 0.3%–2.0%), with no increase in mortality among patients who received NAC. Conclusions: The use of perioperative systemic therapy for UTUC in Japan increased over the study period, with growing adoption of NAC, AT, and adjuvant nivolumab. Postoperative mortality remained stable, showing no notable association with NAC. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10147-026-03198-6.
SN - 1341-9625
SN - 1437-7772
ER -