A multi-centre review of neoadjuvant chemotherapy administration rates related to Robotic-assisted Radical Cystectomy and the impact on pathological staging

509 Background: Neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) with bilateral pelvic lymph node dissection is the current standard of care for MIBC. Pathologic downstaging with NAC is an important surrogate endpoint and associated with overall survival benefit. There have been questions about the impact of delay in definitive surgery because of NAC. The optimal timing of surgery from the start of NAC is uncertain. We studied this question using National Cancer Database (2004-2015). Methods: We identified patients with MIBC (cT2-T4aN0M0 & cT1-T4aN1M0) who received NAC within 6 months of diagnosis and underwent surgery between 10 weeks and 9 months of the start day of NAC. We excluded patients who died within 30 days of surgery. Time period was stratified into three cohorts; 11-16, 17-24, and ≥25 weeks from the start day of NAC. Descriptive analysis, Kaplan-Meier plots, Log-Rank tests for univariate and proportional hazards models for multivariate survival analyses were performed. Results: 3709 patients were identified; 75% were males, 77% cases were cT2 and 73% had charlson-deyo score (CS) of '0'. Median time for surgery 10 weeks after start of NAC was 118 days. Forty-two (42%) had surgery in 11-16, 47% in 17-24 and 9.9% in ≥25 weeks. Majority (60%) were treated at academic and 24% at comprehensive community. Only 29% achieved complete pathological complete response rate (Tis or T0). On univariate analysis receiving NAC within 3 months of diagnosis was significantly associated with survival benefit (p < 0.001). Cox-regression results showed that patients who underwent surgery in 11-16 and 17-24 week time period had significantly better survival than > 25 week group with HR of 0.84 (0.71- 0.98) and 0.82 (0.70-0.97) respectively. In addition patients with CS of '0' had better survival with HR 0.78 (0.62-0.90) and > 75 years of age was associated with worse survival HR 1.73 (1.35-2.22). Conclusions: Our study indicates that appropriate patients with MIBC benefit from receiving surgery within 24 weeks of starting NAC. However, randomized prospective study is warranted to further explore the role of delay of surgery from NAC.

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MP26-09 THE CONTEMPORARY USE OF NEOADJUVANT CHEMOTHERAPY PRIOR TO RADICAL CYSTECTOMY FOR UROTHELIAL CANCER: THE IMPACT OVER A 13 YEAR PERIOD

The Journal of Urology ◽

10.1097/01.ju.0000555674.21237.9b ◽

2019 ◽

Vol 201 (Supplement 4) ◽

Author(s):

Anojan Navaratnam* ◽

Kyle Rose ◽

Haidar Abdul-Muhsin ◽

Kassem Faraj ◽

Laila Elias ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Radical Cystectomy ◽

Urothelial Cancer ◽

The Impact

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Associations between baseline body composition and cancer-specific mortality following neoadjuvant chemotherapy and radical cystectomy for bladder cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e17015 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e17015-e17015

Author(s):

Leonidas Nikolaos Diamantopoulos ◽

Steven Ngo ◽

Reno Maldonado ◽

Ryan Blair O'Malley ◽

Grace Laidlaw ◽

...

Keyword(s):

Skeletal Muscle ◽

Bladder Cancer ◽

Body Composition ◽

Neoadjuvant Chemotherapy ◽

Radical Cystectomy ◽

Cross Sectional ◽

Specific Mortality ◽

Cancer Specific Mortality ◽

Total Body ◽

The Impact

e17015 Background: Sarcopenia is a modifiable risk factor independently associated with cancer-specific mortality (CSM) in bladder cancer (BC). Sarcopenic obesity, where obesity is measured by fat mass index [FMI, total body fat (kg)/height(m)2], has been proposed as an additive insult. To date, studies have overwhelmingly been performed in patients treated without neoadjuvant chemotherapy (NAC). Herein, we evaluate associations between baseline skeletal muscle index (SMI), FMI, and CSM in patients treated with NAC and radical cystectomy (RC). Methods: Lumbar SMI (cross sectional area of skeletal muscle/height2, cm2/m2) was measured on a computed tomography (CT) image at the level of the third lumbar vertebral body, within 60 days prior to NAC. Total body FMI was calculated from visceral and subcutaneous fat cross-sectional areas. Patients were classified as being sarcopenic, according to sex-specific consensus definitions: Male: SMI < 55, Female: SMI < 39, and as obese if Male: FMI > 9, Female: > 13. Cancer-specific survival (CSS) was estimated using the Kaplan Meier method. Associations with CSM were summarized with multivariable Cox proportional hazards models. Results: 143 patients had CT scans of sufficient quality (2005-18). There were no significant differences in clinicopathologic characteristics between the study cohort and patients without available imaging (N = 261). Cisplatin-based NAC was given to 125 patients (87%), and 18 (13%) received other regimens. In total, 86 (60%) patients were sarcopenic, 52 (36%) obese, and 25 (17%) both sarcopenic and obese, while 48 (34%) were sarcopenic with normal FMI. Median follow-up was 2.7 years (IQR 1.2-6.2), and 43 patients died from BC. Three-year CSS was 61% (sarcopenic) vs. 77% (p < 0.05). Sarcopenic patients with normal FMI had the worst 3-year CSS (55%) compared to those with sarcopenia and FMI-obesity (79%), normal SMI with FMI-obesity (69%), and normal body composition (88%, p = 0.03). On multivariable analysis, neither FMI (HR: 0.77, 95% CI: 0.47-1.3, p = 0.3) nor SMI was independently associated with CSM (HR: 0.98, 95% CI: 0.96-1, p = 0.07) after adjustment for ASA score, pathologic tumor, and nodal stage. Conclusions: In patients treated with NAC+RC, pretreatment SMI trended towards independently predicting risk of CSM. Patients with sarcopenia and normal fat demonstrated the worst CSS. Further study is warranted on the impact of NAC on body composition and the role of the latter in risk stratification of this high-risk patient population.

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Nutritional Status Impairment Due to Neoadjuvant Chemotherapy Predicts Post-Radical Cystectomy Complications

Nutrients ◽

10.3390/nu13124471 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4471

Author(s):

Sharon Cohen ◽

Jonathan Gal ◽

Yuval Freifeld ◽

Sobhi Khoury ◽

Yoram Dekel ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Nutritional Status ◽

Radical Cystectomy ◽

Psoas Muscle ◽

Nutritional Intervention ◽

Status Change ◽

Muscle Area ◽

Cross Sectional ◽

Increased Risk ◽

The Impact

Background: Radical cystectomy (RC) is the standard treatment for muscle invasive bladder cancer (MIBC). Neoadjuvant chemotherapy (NAC) is associated with improved patient survival. The impact of NAC on nutritional status is understudied, while the association between malnutrition and poor surgical outcomes is well known. This study aims to examine the association between NAC, nutritional status impairment, and post-operative morbidity. Materials and Methods: We included MIBC patients who underwent RC and received NAC from multiple academic centers in Israel. Cross-sectional imaging was used to measure the psoas muscle area and normalized it by height (smooth muscle index, SMI). Pre- and post-NAC SMI difference was calculated (represents nutritional status change). The primary outcomes were post-RC ileus, infection, and a composite outcome of any complication. Logistic regression models were fit to identify independent predictors of the outcomes. Results: Ninety-one patients were included in the study. The median SMI change was −0.71 (−1.58, −0.06) cm2/m2. SMI decline was significantly higher in patients with post-RC complications (−18 vs. −203, p < 0.001). SMI change was an independent predictor of all complications, ileus, infection, and other complications. The accuracy of SMI change for predicting all complications, ileus, infection, and other complications was 0.85, 0.87, 0.75, and 0.86, respectively. Conclusions: NAC-related nutritional deterioration is associated with increased risk of complications after RC. Our results hint towards the need for nutritional intervention during NAC prior to RC.

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The impact of socio-economic deprivation on recovery following robotic assisted radical cystectomy

European Urology Open Science ◽

10.1016/s2666-1683(21)03215-8 ◽

2021 ◽

Vol 33 ◽

pp. S396

Author(s):

W. Hasan ◽

W. Abou Chedid ◽

G. Nason ◽

T. Mahesan ◽

A. Ashton ◽

...

Keyword(s):

Radical Cystectomy ◽

Economic Deprivation ◽

Robotic Assisted ◽

The Impact

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Impact of Clinical Response to Neoadjuvant Chemotherapy in the Era of Robot Assisted Radical Cystectomy: Results of a Single-Center Experience

Journal of Clinical Medicine ◽

10.3390/jcm9092736 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2736

Author(s):

Umberto Anceschi ◽

Aldo Brassetti ◽

Gabriele Tuderti ◽

Maria Consiglia Ferriero ◽

Manuela Costantini ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Radical Cystectomy ◽

Residual Disease ◽

Independent Predictor ◽

Multivariable Analysis ◽

Complete Response ◽

Rank Test ◽

Single Center Experience ◽

The Impact ◽

Response To Neoadjuvant Chemotherapy

Background: Response to neoadjuvant chemotherapy (NACT) has been proven to be an established prognostic factor after open radical cystectomy (ORC). We evaluated the impact of NACT on survival outcomes of a single-institution robotic radical cystectomy (RARC) series. Methods: From January 2012 to June 2020, 79 patients were identified. Baseline, demographic, perioperative, and pathologic data were described. Kaplan–Meier with the log-rank test was used to compare overall survival (OS) differences between complete, partial, and no-NACT responders, respectively. Univariable and multivariable regression analyses were performed to identify predictors of OS. Results: Complete, partial, and absent response to NACT were recorded in 43 (54.4%), 21 (19%), and 15 (26.6%) patients, respectively. A complete response to NACT displayed a trend toward significant higher OS (p = 0.03). In univariable analysis, significant predictors of lower OS were hypertension (HR 3.37; CI 95% 1.31–8.62; p = 0.01); advanced nodal involvement (HR 2.41; CI 95% 0.53–10.9; p < 0.001); and incomplete response to NACT (HR 0.41; CI 95% 0.18–0.95; p = 0.039). In multivariable analysis, the only independent predictor of worse OS was advanced pathologic N stages (HR 10.1; CI: 95% CI 2.3–44.3; p = 0.002). Conclusions: Complete response to NACT is associated with increased OS probability, but significant nodal residual disease remains the only independent predictor of OS after RARC.

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