Re: Effectiveness of Adjuvant Chemotherapy after Radical Cystectomy for Locally Advanced and/or Pelvic Lymph Node-Positive Muscle-Invasive Urothelial Carcinoma of the Bladder: A Propensity Score-Weighted Competing Risks Analysis

299 Background: Urothelial carcinoma of the bladder is among the 5 most common cancers in the US. Despite several clinical trials attempting to determine the best approach to muscle-invasive disease, the optimal treatment modalities and their sequence have not been established. Specifically, the decision to administer neo-adjuvant chemotherapy is currently based solely on clinical parameters, with no validated biomarkers. Micro-RNAs (miRNAs) are short RNA molecules that have roles in post-transcriptional gene expression regulation by binding to mRNAs. They were shown to have cardinal roles in many cancers, and their potential to serve as biomarkers is extensively studied. Our goal was to study whether miRNAs can serve as predictive biomarkers for response to neo-adjuvant chemotherapy in urothelial carcinoma. Methods: miRNAs were extracted from paraffin-embedded pre-operative muscle-invasive tumor biopsies of patients diagnosed with urothelial carcinoma, whose pathological surgical specimen was later found to either show complete or no-response to neo-adjuvant chemotherapy (termed 'responders' and 'non-responders', respectively). The expression pattern of approximately 900 miRNAs was compared using a commercial miRNA array, and the levels of candidate miRNAs was further assessed by quantitative real-time PCR (qRT-PCR). Results: The vast majority of miRNAs exhibited a similar expression pattern in the two patient groups, but two miRNAs were significantly lower in the responders (p <0.001 and q<0.1 using the false detection rate (FDR) method). Interestingly, both miRNAs can potentially target the mRNA of PTCH1 and SP5, two genes with known tumor-suppressor functions. qRT-PCR showed that high levels of one of the miRNAs correlated with lack of response to chemotherapy. Conclusions: This retrospective analysis identified two miRNAs that are differentially expressed between chemotherapy responders and non-responders. One of these miRNAs was confirmed to correlate with lack of response to neo-adjuvant chemotherapy. A prospective trial assessing the predictive values of these miRNAs is currently underway. Future research directions and potential implications will be discussed.

Download Full-text

Effect of adjuvant chemotherapy in locally advanced urothelial carcinoma of the bladder treated with cystectomy

Actas Urológicas Españolas (English Edition) ◽

10.1016/j.acuroe.2019.08.005 ◽

2020 ◽

Vol 44 (2) ◽

pp. 94-102

Author(s):

G. del Pozo Jiménez ◽

F. Herranz Amo ◽

J.A. Arranz Arija ◽

E. Rodríguez Fernández ◽

D. Subirá Ríos ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Urothelial Carcinoma ◽

Locally Advanced ◽

Carcinoma Of The Bladder ◽

Advanced Urothelial Carcinoma

Download Full-text

The role of adjuvant chemotherapy for lymph node-positive upper tract urothelial carcinoma following radical nephroureterectomy: a retrospective study

BJU International ◽

10.1111/bju.12801 ◽

2015 ◽

Vol 116 (1) ◽

pp. 72-78 ◽

Cited By ~ 22

Author(s):

Ilaria Lucca ◽

Wassim Kassouf ◽

Anil Kapoor ◽

Adrian Fairey ◽

Ricardo A. Rendon ◽

...

Keyword(s):

Lymph Node ◽

Retrospective Study ◽

Adjuvant Chemotherapy ◽

Urothelial Carcinoma ◽

Upper Tract Urothelial Carcinoma ◽

Radical Nephroureterectomy ◽

Upper Tract ◽

Node Positive ◽

Lymph Node Positive

Download Full-text

The role of adjuvant chemotherapy in patients with locally advanced (pT3, pT4a) and/or lymph node–positive bladder cancer

International Urology and Nephrology ◽

10.1007/s11255-010-9736-5 ◽

2010 ◽

Vol 42 (4) ◽

pp. 959-964 ◽

Cited By ~ 2

Author(s):

Berkan Reşorlu ◽

Kadir Türkölmez ◽

Gül Ergün ◽

Sümer Baltacı ◽

Çağatay Göğüş ◽

...

Keyword(s):

Bladder Cancer ◽

Lymph Node ◽

Adjuvant Chemotherapy ◽

Locally Advanced ◽

Node Positive ◽

Lymph Node Positive

Download Full-text

558 Perinodal lymphovascular invasion displays the strongest predictor for cancer-specific mortality in lymph node positive patients with urothelial carcinoma of the bladder

European Urology Supplements ◽

10.1016/s1569-9056(12)60555-7 ◽

2012 ◽

Vol 11 (1) ◽

pp. e558-e558a

Author(s):

S. Brookman-May ◽

M. Burger ◽

M. May ◽

S. Denzinger ◽

M. Gierth ◽

...

Keyword(s):

Lymph Node ◽

Urothelial Carcinoma ◽

Lymphovascular Invasion ◽

Node Positive ◽

Specific Mortality ◽

Cancer Specific Mortality ◽

Lymph Node Positive ◽

Carcinoma Of The Bladder

Download Full-text

Adjuvant chemotherapy after radiotherapy or concurrent chemoradiotherapy for pelvic lymph node-positive patients with locally advanced cervical cancer: a propensity score matching analysis

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001230 ◽

2020 ◽

pp. ijgc-2020-001230

Author(s):

Yidi Yuan ◽

Jing You ◽

Xiaofan Li ◽

Weihu Wang

Keyword(s):

Lymph Node ◽

Adjuvant Chemotherapy ◽

Propensity Score ◽

Propensity Score Matching ◽

Concurrent Chemoradiotherapy ◽

Cervical Squamous Cell Carcinoma ◽

Pelvic Lymph Node ◽

Free Survival ◽

Node Positive ◽

Lymph Node Positive

ObjectiveThe benefit of adjuvant chemotherapy after definitive chemoradiotherapy in patients with pelvic lymph node-positive cervical cancer has been poorly studied. This study aimed to test the hypothesis that the addition of adjuvant chemotherapy to definitive radiotherapy or concurrent chemoradiotherapy improves survival in patients with pelvic lymph node-positive cervical squamous cell carcinoma.MethodsThis retrospective study enrolled patients with stage IB–IVA pelvic lymph node-positive cervical squamous cell carcinoma, without para-aortic lymph node metastases and initially treated with definitive radiotherapy or concurrent chemoradiotherapy between March 2007 and February 2018. Patients were classified into the adjuvant chemotherapy (5-fluorouracil or paclitaxel, plus cisplatin) and no-adjuvant chemotherapy groups. Treatment outcomes were compared between the two groups before and after 1:1 ratio propensity score matching.ResultsMedical records of 951 patients were reviewed and 792 patients were excluded. Finally, 159 patients were enrolled for analysis. Of these, 42 patients received a median of two cycles (range, 1–6) of adjuvant chemotherapy and 117 patients under observation after primary treatment. The median follow-up period was 33.8 months (range, 2.9–113.0). Before propensity score matching, no significant difference was observed in survivals between the two groups (P>0.05). After propensity score matching, 37 pairs of patients were selected. The 3-year rates of progression-free survival, overall survival, local control, and distant metastasis-free survival in the adjuvant chemotherapy and no-adjuvant chemotherapy groups were 80.2% and 60.4% (P=0.07), 83.0% and 63.7% (P=0.17), 94.0% and 81.9% (P=0.12), and 85.9% and 60.1% (P=0.04), respectively. The incidences of grade 3–4 acute and late toxicities were comparable between the two groups (P>0.05).DiscussionAdjuvant chemotherapy significantly improved 3-year distant metastasis-free survival in patients with pelvic lymph node-positive cervical squamous cell carcinoma. Further prospective studies are needed to provide supportive evidence for the therapeutic efficacy of adjuvant chemotherapy.

Download Full-text