MP32-15 CIGARETTE SMOKING IS ASSOCIATED WITH ADVERSE PATHOLOGIC RESPONSE AND INCREASED DISEASE RECURRENCE AMONG PATIENTS WITH MUSCLE-INVASIVE BLADDER CANCER TREATED WITH CISPLATIN-BASED NEOADJUVANT CHEMOTHERAPY AND RADICAL CYSTECTOMY

Abstract Background Most patients with muscle-invasive bladder cancer (MIBC) developed metastasis within 2 years, even after radical cystectomy (RC). The recurrence rate of MIBC was more than 50% of the cases. A meta-analysis conducted by Yin et al. showed that neoadjuvant chemotherapy (NAC) + RC improves overall survival in MIBC compared with RC only. However, a new meta-analysis by Li et al. concluded that NAC + RC was not superior to RC only in improving overall survival. The inconsistencies of these studies required further comprehensive analysis to recommend NAC use in bladder cancer treatment. Therefore, this meta-analysis aims to analyze previous studies that compare the efficacy of NAC + RC versus RC only to improve overall survival of MIBC. Methods The articles were searched using Pubmed with keywords “muscle-invasive bladder cancer”, “neoadjuvant chemotherapy”, “cystectomy”, and “overall survival”. The articles that were published until June 2020 were screened. The overall survival outcome was analyzed as hazard ratio (HR) and presented in a forest plot. Result Seventeen studies were included in meta-analysis with a total sample of 13,391 patients, consist of 2890 received NAC followed by RC and 10,418 underwent RC only. Two studies used methotrexate/vinblastine/doxorubicin/cisplatin (MVAC), two studies used gemcitabine/cisplatin (GC), one study used Cisplatin-based regimen, one study used MVAC or GC, one study used gemcitabine/carboplatin (GCarbo) or GC or MVAC, one study used Cisplatin/Gemcitabine or MVAC, one study used Cisplatin only, one study used Cisplatin-based (GC, MVAC) or non-Cisplatin-based (combined paclitaxel/gemcitabine/carboplatin), one study used GC, MVAC, Carboplatin, or Gemcitabine/Nedaplatin (GN), and five studies did not mention the regimen The overall survival in the NAC + RC only group was significantly better than the RC only group (HR 0.82 [0.71–0.95], p = 0.009). Conclusion NAC + RC is recommended to improve overall survival in MIBC patients. A further study assessing side effects and quality of life regarding NAC + RC is needed to establish a strong recommendation regarding this therapy.

Download Full-text

Fewer tumour draining sentinel nodes in patients with progressing muscle invasive bladder cancer, after neoadjuvant chemotherapy and radical cystectomy

World Journal of Urology ◽

10.1007/s00345-019-03025-w ◽

2019 ◽

Vol 38 (9) ◽

pp. 2207-2213

Author(s):

Julia Alvaeus ◽

Robert Rosenblatt ◽

Markus Johansson ◽

Farhood Alamdari ◽

Tomasz Jakubczyk ◽

...

Keyword(s):

Bladder Cancer ◽

Neoadjuvant Chemotherapy ◽

Radical Cystectomy ◽

Progressive Disease ◽

Clinical Staging ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Sentinel Nodes ◽

Muscle Invasive ◽

The Relationship

Abstract Purpose To examine the relationship between the number of tumour draining sentinel nodes (SNs) and pathoanatomical outcomes, in muscle-invasive bladder cancer (MIBC), in patients undergoing neoadjuvant chemotherapy (NAC) and radical cystectomy (RC). Materials and Methods In an ongoing prospective multicenter study, we included 230 patients with suspected urothelial MIBC from ten Swedish urological centers. All underwent TURb and clinical staging. From the cohort, 116 patients with urothelial MIBC; cT2-cT4aN0M0, underwent radical cystectomy (RC) and lymphadenectomy with SN-detection (SNd). 83 patients received cisplatin-based NAC and 33 were NAC-naïve. The number and locations of detected SNs and non-SNs were recorded for each patient. The NAC treated patients were categorized by pathoanatomical outcomes post-RC into three groups: complete responders (CR), stable disease (SD) and progressive disease (PD). Selected covariates with possible impact on SN-yield were tested in uni -and multivariate analyses for NAC-treated patients only. Results In NAC treated patients, the mean number of SNs was significantly higher in CR patients (3.3) and SD patients (3.6) compared with PD patients (1.4) (p = 0.034). In a linear multivariate regression model, the number of harvested nodes was the only independent variable that affected the number of SNs (p = 0.0004). Conclusions The number of tumor-draining SNs in NAC-treated patients was significantly lower in patients with progressive disease.

Download Full-text

Clinical predictors and survival outcome of patients receiving suboptimal neoadjuvant chemotherapy and radical cystectomy for muscle-invasive bladder cancer: a single-center experience

World Journal of Urology ◽

10.1007/s00345-019-02689-8 ◽

2019 ◽

Vol 37 (11) ◽

pp. 2409-2418 ◽

Cited By ~ 2

Author(s):

Luca Boeri ◽

Matteo Soligo ◽

Igor Frank ◽

Stephen A. Boorjian ◽

R. Houston Thompson ◽

...

Keyword(s):

Bladder Cancer ◽

Neoadjuvant Chemotherapy ◽

Radical Cystectomy ◽

Survival Outcome ◽

Invasive Bladder Cancer ◽

Single Center ◽

Clinical Predictors ◽

Muscle Invasive Bladder Cancer ◽

Single Center Experience ◽

Muscle Invasive

Download Full-text

Should we spare neoadjuvant chemotherapy in low-risk muscle-invasive bladder cancer patients scheduled for radical cystectomy?

Translational Andrology and Urology ◽

10.21037/tau.2019.04.04 ◽

2019 ◽

Vol 8 (S3) ◽

pp. S283-S286

Author(s):

Günter Niegisch

Keyword(s):

Bladder Cancer ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Radical Cystectomy ◽

Low Risk ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Muscle Invasive

Download Full-text

Predictors of pathologic response after radical cystectomy for muscle invasive bladder cancer: A population-based analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.503 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 503-503

Author(s):

Shane M. Pearce ◽

Akbar Ashrafi ◽

Matthew Winter ◽

Saum Ghodoussipour ◽

Daniel Zainfeld ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Clinical Stage ◽

Multivariable Analysis ◽

Pathologic Response ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Academic Center ◽

Muscle Invasive ◽

Over Time

503 Background: Neoadjuvant chemotherapy (NAC) improves overall survival (OS) for patients with muscle invasive bladder cancer (MIBC) undergoing radical cystectomy (RC), possibly through an increase in pathologic complete response (CR), defined as a pathologic stage T0 (pT0). We sought to identify predictors of CR for MIBC. Methods: The National Cancer Database from 2004 to 2013 was used to identify patients with cT2-4cN0cM0 urothelial cell carcinoma treated with RC. Patients were grouped based on pathology as CR (pT0), partial response (PR – pTa/Tis/T1) or no response (NR - pT2 or higher). Predictors of NAC and CR were identified with multivariable logistic regression. Cox proportional hazards model was used to compare OS based on cT stage, receipt of NAC and pathologic response. Results: The study population included 10,820 patients and NAC was administered in 16.4%. Use of NAC was associated with higher cT stage (p < 0.01) and increased over time (10% from 2003-2007 vs. 24% from 2011-2013, p < 0.01). Predictors of NAC use on multivariable analysis include younger age, lower comorbidity score, treatment at an academic center, and diagnosis from 2011-2013 (p < 0.01). Overall, CR was achieved in 3.3% without NAC and 16.3% with NAC (p < 0.01). NAC improved 5-year OS for all cT stages, however the survival benefit was only observed among those achieving CR (p < 0.01). Multivariable Cox regression demonstrates that both PR (HR 0. 58, p < 0.01) and CR (OR 0.26, p < 0.01) were independently associated with improved OS among those treated with NAC. Multivariable analysis identified age (OR 0.98, p < 0.01) and increased clinical stage (cT3: OR 0.47, p < 0.01; cT4 OR 0.54, p < 0.01) as negative predictors of CR. Utilization of NAC (OR 4.82 p < 0.01), academic institution, and diagnosis 2011-2013 (OR 1.92, p < 0.01) increased the odds of CR. Conclusions: Use of NAC increased over time and CR occurred in 16% of patients who received NAC. Treatment at an academic center, diagnosis from 2011-2013 and use of NAC were independently associated with CR, while increased age and clinical stage were negative predictors of CR. PR and CR are independently associated with improved OS relative to non-responders.

Download Full-text