Circulating and Urine Tumor DNA Dynamics Predict Minimal Residual Disease and Recurrence Risk in Locally Advanced Upper Tract Urothelial Carcinoma

NCT ID: NCT05595408

Last Updated: 2025-12-09

Basic Information

• Recruitment Status: RECRUITING
• Total Enrollment: 84 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2022-02-01
• Study Completion Date: 2026-12-31

Brief Summary

In our study, the ultra-deep sequencing of circulating tumor DNA (ctDNA) and urine tumor DNA (utDNA) were performed to assess whether ctDNA and utDNA can be used as predictive biomarkers for the detection of minimal residual disease (MRD) and early diagnosis of UTUC recurrence, and explored the role of ctDNA and utDNA detection of MRD in the prediction of adjuvant therapy efficacy and prognostic evaluation.

Detailed Description

60% of Upper Urinary Tract Urothelial Carcinoma (UTUC) patients with muscle-invasive disease at diagnosis, which progresses rapidly, aggressively, and has a poor prognosis. Up to 30-40% of the patients may develop bladder recurrance after radical nephroureterectomy for primary upper tract urothelial carcinoma.

Minimal residual disease (MRD) refers to the small number of malignant cells that remain after curative treatments (curative intent surgical resection, radiotherapy, and/or chemotherapy). MRD is common in patients with blood cancer, and is known to be associated with recurrence and poor prognosis. Recent studies also reported that MRD-negative in postoperative solid tumors such as colorectal/colon cancer and muscle-invasive bladder cancer is associated with better survival outcomes. However, the clinical values of MRD monitoring for adjuvant therapy in postoperative UTUC remain inadequate.

A total of 84 patients with stage II-IV UTUC will be recruited in this clinical trial. The following plasma samples, urine samples and tumor tissues will be collected from each patient including T0 (preoperatively, 2[1-3] days before surgery), T1 (28±3 days postoperatively), T2 (within 7 days after cycle 2 adjuvant therapy), T3 (end-of-treatment), and quarterly/semi-annually during surveillance (T4-T6) until recurrence/24 months. In addition, demographic and tumor characteristics of the patients will be collected for subsequent analysis, including age, sex, tumor stage, pathological stage, disease couse time, etc. Tumor tissues and matched peripheral blood were collected before treatment and WES was used ctDNA detection techniques. For each patient, we selected up to 40 clonal somatic mutations for personalized, tumor informed ctDNA assay design.Statistical analyses will be performed to analyze the survival outcomes and to explore the clinical value of MRD monitoring for adjuvant therapy in postoperative UTUC.

Conditions

Muscle Invasive Upper Tract Urothelial Carcinoma

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

adjuvant chemotherapy group

muscle invasive upper tract urothelial carcinoma after radical nephroureterectomy receiving adjuvant chemotherapy

Adjuvant chemotherapy

Intervention Type: DRUG

cisplatin/carboplatin-gemcitabine 4-6 cycles

adjuvant immunotherapy group

muscle invasive upper tract urothelial carcinoma after radical nephroureterectomy receiving adjuvant immunotherapy

adjuvant immunotherapy

Intervention Type: DRUG

immunotherapy for one year

Interventions

Adjuvant chemotherapy

cisplatin/carboplatin-gemcitabine 4-6 cycles

Intervention Type: DRUG

adjuvant immunotherapy

immunotherapy for one year

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• pathological comfirmed T2-4 or N+ and M0 upper tract urothelial carcinoma
• Male or female aged ≥18 years old who are willing to sign the informed consent form
• have no distant metastasis
• have an ECOG 0 to 2
• upper tract urothelial carcinoma patients received radical nephroureterectomy
• have no multiple primary carcinoma
• received adjuvant chemotherapy or immunotherapy after surgery within 12 weeks
• ≥2 postoperative liquid biopsy assessments (T1 and T2)

Exclusion Criteria

• a prior history of bladder or synchronous bladder cancer
• Pregnant or lactating women, or patients who are fertile but do not take contraceptive measures;
• Severe infection;
• Severe heart disease;
• Uncontrollable neurological or mental disorders;
• Severe diabetes mellitus;
• Patients with severe autoimmune diseases.
• Neoadjuvant therapy exposure
• No bilateral UTUC
• Surveillance time < month
• <2 postoperative MRD surveillance assessments

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

RenJi Hospital

OTHER

Sponsor Role: lead

West China Hospital

OTHER

Sponsor Role: collaborator

Responsible Party

Responsibility Role: SPONSOR

Locations

Renji Hospital

Shanghai, Shanghai Municipality, China

Site Status: RECRUITING

Countries

China

Central Contacts

jiwei huang, M.D

Role: CONTACT

huangjiwei@renji.com

8613651682825

Facility Contacts

jiwei huang, M.D

Role: primary

huangjiwei@renji.com

8621-68383716

Other Identifiers

CURATE-UTUC

Identifier Type: -

Identifier Source: org_study_id