Impact of neoadjuvant chemotherapy on survival and recurrence patterns after robot‐assisted radical cystectomy for muscle‐invasive bladder cancer: Results from the International Robotic Cystectomy Consortium

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.

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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.

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Cigarette smoking is associated with adverse pathological response and increased disease recurrence amongst patients with muscle-invasive bladder cancer treated with cisplatin-based neoadjuvant chemotherapy and radical cystectomy: a single-centre experien

BJU International ◽

10.1111/bju.14612 ◽

2019 ◽

Vol 123 (6) ◽

pp. 1011-1019 ◽

Cited By ~ 13

Author(s):

Luca Boeri ◽

Matteo Soligo ◽

Igor Frank ◽

Stephen A. Boorjian ◽

Robert H. Thompson ◽

...

Keyword(s):

Bladder Cancer ◽

Neoadjuvant Chemotherapy ◽

Cigarette Smoking ◽

Radical Cystectomy ◽

Disease Recurrence ◽

Pathological Response ◽

Invasive Bladder Cancer ◽

Single Centre ◽

Muscle Invasive Bladder Cancer ◽

Muscle Invasive

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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

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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

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Robot-Assisted Radical Cystectomy with Intra-corporeal Neo-Bladder

10.5772/intechopen.98973 ◽

2021 ◽

Author(s):

Víctor Enrique Corona-Montes ◽

Eduardo Gonzalez-Cuenca ◽

Laurent López ◽

Juan Eduardo Sánchez-Núñez ◽

Richard Gaston

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Gold Standard ◽

Invasive Bladder Cancer ◽

Intraoperative Blood Loss ◽

Robot Assisted ◽

Muscle Invasive Bladder Cancer ◽

Oncological Results ◽

Muscle Invasive ◽

Continent Urinary Reservoir

The purpose of this chapter is to provide a step-by-step description of the robot-assisted radical cystectomy with an intra-corporeal neo-bladder technique and a recent review of its outcomes. The procedure is also known as anterior pelvic exenteration or cysto-prostatectomy in the case of female or male respectively. Radical cystectomy (RC) is the gold standard treatment for muscle-invasive bladder cancer, but there are also several surgical indications for non-muscle-invasive bladder cancer. In the past years, minimally invasive surgery and the da Vinci system technology have played a major role in this procedure, with description of brand-new techniques and specific approaches for the creation of a continent urinary reservoir. The following chapter provides a detailed description of the robot-assisted radical cystectomy (RARC) with Y-shaped intra-corporeal bladder as well as a literary review of distinct perioperative, functional and oncological outcomes from the available RARC randomized controlled trials. Despite its high cost and complexity, the intra-corporeal technique has become widely popular around the world and is used more frequently each time. The described data in this chapter, demonstrates that morbidity can be reduced whilst simultaneously offer non-inferior oncological results and less intraoperative blood loss in contrast to the open RC approach.

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