OBJECTIVE: To analyse the outcome after radical cystectomy (RC) in patients with clinical T2 bladder cancer not responding to neoadjuvant chemotherapy (NAC). PATIENTS AND METHODS: In a retrospective analysis, study patients received NAC for clinical T2 disease before RC and a control group had RC for clinical T2 disease with no NAC. Patients treated with NAC were further grouped based on the pathological response; failure to respond was defined as 'no change in T stage or a higher T stage in the RC specimen (>or=pT2)', and the relevant clinical and pathological data were analysed. RESULTS: In all, 53 patients satisfied the inclusion criteria for the study group and 200 for the control group. In the study group 18 (34%) responded to NAC (group 1) of whom 11 (61%) were pT0 and seven (39%) pT1, and among the non-responders (group 2) 19 (54%) were pT3/pT4 and 16 (46%) were pT2; 16 (46%) patients in group 2 had lymph node metastasis. The mean follow-up was 26 months. In group 2, local recurrence occurred in six (17%) vs none in group 1. Seven patients (20%) in group 2 developed metastases, vs one (5%) in group 1 (P = 0.01). The 5-year disease-free survival was significantly lower for group 2 (40%) than group 1 (91%, P = 0.007) and the control group (67%, P = 0.04). There were 14 deaths from bladder cancer in group 2, vs one in group I (P = 0.01). The 5-year disease-specific survival was significantly lower for group 2 (52%) than group 1 (83%, P = 0.008) and the control group (70%, P = 0.001). CONCLUSION: A lack of response to NAC is associated with a significantly higher local and distant recurrence, and with lower survival.
OBJECTIVE: To analyse the outcome after radical cystectomy (RC) in patients with clinical T2 bladder cancer not responding to neoadjuvant chemotherapy (NAC). PATIENTS AND METHODS: In a retrospective analysis, study patients received NAC for clinical T2 disease before RC and a control group had RC for clinical T2 disease with no NAC. Patients treated with NAC were further grouped based on the pathological response; failure to respond was defined as 'no change in T stage or a higher T stage in the RC specimen (>or=pT2)', and the relevant clinical and pathological data were analysed. RESULTS: In all, 53 patients satisfied the inclusion criteria for the study group and 200 for the control group. In the study group 18 (34%) responded to NAC (group 1) of whom 11 (61%) were pT0 and seven (39%) pT1, and among the non-responders (group 2) 19 (54%) were pT3/pT4 and 16 (46%) were pT2; 16 (46%) patients in group 2 had lymph node metastasis. The mean follow-up was 26 months. In group 2, local recurrence occurred in six (17%) vs none in group 1. Seven patients (20%) in group 2 developed metastases, vs one (5%) in group 1 (P = 0.01). The 5-year disease-free survival was significantly lower for group 2 (40%) than group 1 (91%, P = 0.007) and the control group (67%, P = 0.04). There were 14 deaths from bladder cancer in group 2, vs one in group I (P = 0.01). The 5-year disease-specific survival was significantly lower for group 2 (52%) than group 1 (83%, P = 0.008) and the control group (70%, P = 0.001). CONCLUSION: A lack of response to NAC is associated with a significantly higher local and distant recurrence, and with lower survival.
Authors: Paul Sargos; Brian C Baumann; Libni J Eapen; Amit Bahl; Vedang Murthy; Guilhem Roubaud; Mathieu Orré; Jason A Efstathiou; Shahrokh Shariat; Stephane Larré; Pierre Richaud; John P Christodouleas Journal: Transl Androl Urol Date: 2016-10
Authors: Eugene J Pietzak; Emily C Zabor; Aditya Bagrodia; Joshua Armenia; Wenhuo Hu; Ahmet Zehir; Samuel Funt; Francois Audenet; David Barron; Noelia Maamouri; Qiang Li; Min Yuen Teo; Maria E Arcila; Michael F Berger; Nikolaus Schultz; Guido Dalbagni; Harry W Herr; Dean F Bajorin; Jonathan E Rosenberg; Hikmat Al-Ahmadie; Bernard H Bochner; David B Solit; Gopa Iyer Journal: Eur Urol Date: 2018-10-02 Impact factor: 24.267