{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T08:29:16Z","timestamp":1787905756407,"version":"build-2784847793"},"reference-count":25,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the impact of renal impairment (RI) on the efficacy of first\u2010line chemotherapy in patients with locally advanced or metastatic upper tract urothelial carcinoma (la\/mUTUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This multicenter retrospective study evaluated 300 patients with la\/mUTUC who received GEM\/CDDP or GEM\/CBDCA as first\u2010line chemotherapy. RI was defined as eGFR &lt;\u200945\u2009mL\/min\/1.73\u2009m\n                      <jats:sup>2<\/jats:sup>\n                      and used to categorize patients into RI and without\u2010RI groups. Objective response rate (ORR), progression\u2010free survival (PFS), and overall survival (OS) were analyzed. Multivariable Cox proportional hazard analysis was conducted to assess risk factors for PFS and OS. In the RI group, oncologic outcomes were compared between GEM\/CDDP and GEM\/CBDCA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 130 patients (43%) had RI, and 170 (57%) did not. During a median follow\u2010up of 32\u2009months, 188 patients (63%) died: 74 patients (56%) in the RI group and 114 (67%) in the without\u2010RI group. Among 288 evaluable patients, the ORR was 34% in the RI group and 45% in the without\u2010RI group (\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u20090.072). The median PFS of the RI and without\u2010RI groups was 5.6 and 4.8\u2009months, respectively (\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u20090.322), and the median OS was 16.9 and 14.5\u2009months, respectively (\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u20090.074). Among the RI group, no significant differences were observed between GEM\/CDDP and GEM\/CBDCA in PFS (6.4 vs. 4.2\u2009months,\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u20090.113) or OS (21.4 vs. 15.2\u2009months,\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u20090.142).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In la\/mUTUC, oncologic outcomes were comparable between patients with and without RI. In the RI group, responses to GEM\/CDDP and GEM\/CBDCA did not differ.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iju.70136","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T08:29:11Z","timestamp":1749025751000},"page":"1369-1378","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Real\u2010World Outcomes of First\u2010Line Systematic Treatment in Locally Advanced or Metastatic Upper Urinary Tract Urothelial Carcinoma With Renal Impairment (\n                    <scp>YUSHIMA<\/scp>\n                    Study)"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2214-6574","authenticated-orcid":false,"given":"Tomoki","family":"Kimura","sequence":"first","affiliation":[{"name":"Department of Urology Institute of Science Tokyo  Tokyo 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