Uros Milenkovic1,2, Murat Akand1,3, Lisa Moris1, Liesbeth Demaegd1, Tim Muilwijk1, Youri Bekhuis1, Annouschka Laenen1, Ben Van Cleynenbreugel1, Wouter Everaerts1,2, Hein Van Poppel1, Herlinde Dumez4, Maarten Albersen1,2, Steven Joniau5. 1. Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium. 2. Laboratory of Experimental Urology, Department of Development and Regeneration, Catholic University of Leuven, Louvain, Belgium. 3. School of Medicine, Department of Urology, Selcuk University, Konya, Turkey. 4. University Hospitals Leuven, Department of General Medical Oncology, Leuven Cancer Institute, KU Leuven, Louvain, Belgium. 5. Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium. steven.joniau@uzleuven.be.
Abstract
OBJECTIVES: To compare perioperative and short-term postoperative complication rates between patients receiving radical cystectomy (RC) after neoadjuvant chemotherapy (NAC) and patients undergoing RC alone. Secondary objectives were to compare overall survival (OS) and cancer-specific survival (CSS). MATERIALS AND METHODS: Clinico-pathological data of all patients who received RC between 1996 and 2015 were retrospectively collected. Only patients with RC for muscle-invasive bladder cancer were included in the final analysis. Short-term (30-day) postoperative complications were assessed by registering the Clavien-Dindo classification (CDC) and dividing into sub-groups: low-grade (LGC) CDC 1-2 and high-grade (HGC) CDC 3-5. To compare populations with similar age, comorbidities and preoperative creatinine, we used a propensity score-adjusted statistical model. Pre- and perioperative predictors of short-term complications were identified using uni- and multivariable models. Survival was assessed using Kaplan-Meier analysis. RESULTS: A total of 491 patients undergoing RC were included, of whom 102 (20.8%) received NAC. After propensity score covariate adjustment, there was no significant difference in postoperative complications between patients undergoing NAC plus RC and RC alone with an overall complication rate of 69% and 66%, respectively. No significant differences in the 30-day HGC rates (11.76% and 11.83%, respectively) were observed. NAC plus RC patients had worse prognostic factors at baseline; nevertheless, after correction for group differences OS and CSS did not differ from RC only group (5-year OS 61.3% vs. 50.2%, and 5-year CSS 61.8% vs. 57.9% respectively, p > 0.05 for all). CONCLUSION: In appropriately selected patients, exposure to NAC is not associated with increased short-term complications.
OBJECTIVES: To compare perioperative and short-term postoperative complication rates between patients receiving radical cystectomy (RC) after neoadjuvant chemotherapy (NAC) and patients undergoing RC alone. Secondary objectives were to compare overall survival (OS) and cancer-specific survival (CSS). MATERIALS AND METHODS: Clinico-pathological data of all patients who received RC between 1996 and 2015 were retrospectively collected. Only patients with RC for muscle-invasive bladder cancer were included in the final analysis. Short-term (30-day) postoperative complications were assessed by registering the Clavien-Dindo classification (CDC) and dividing into sub-groups: low-grade (LGC) CDC 1-2 and high-grade (HGC) CDC 3-5. To compare populations with similar age, comorbidities and preoperative creatinine, we used a propensity score-adjusted statistical model. Pre- and perioperative predictors of short-term complications were identified using uni- and multivariable models. Survival was assessed using Kaplan-Meier analysis. RESULTS: A total of 491 patients undergoing RC were included, of whom 102 (20.8%) received NAC. After propensity score covariate adjustment, there was no significant difference in postoperative complications between patients undergoing NAC plus RC and RC alone with an overall complication rate of 69% and 66%, respectively. No significant differences in the 30-day HGC rates (11.76% and 11.83%, respectively) were observed. NAC plus RC patients had worse prognostic factors at baseline; nevertheless, after correction for group differences OS and CSS did not differ from RC only group (5-year OS 61.3% vs. 50.2%, and 5-year CSS 61.8% vs. 57.9% respectively, p > 0.05 for all). CONCLUSION: In appropriately selected patients, exposure to NAC is not associated with increased short-term complications.
Entities:
Keywords:
Bladder cancer; Complications; Neoadjuvant chemotherapy; Radical cystectomy; Short term
Authors: Ajjai S Alva; Christopher T Tallman; Chang He; Maha H Hussain; Khaled Hafez; James E Montie; David C Smith; Alon Z Weizer; David Wood; Cheryl T Lee Journal: Cancer Date: 2011-05-19 Impact factor: 6.860
Authors: Hans von der Maase; Lisa Sengelov; James T Roberts; Sergio Ricci; Luigi Dogliotti; T Oliver; Malcolm J Moore; Annamaria Zimmermann; Michael Arning Journal: J Clin Oncol Date: 2005-07-20 Impact factor: 44.544
Authors: Atreya Dash; Joseph A Pettus; Harry W Herr; Bernard H Bochner; Guido Dalbagni; S Machele Donat; Paul Russo; Mary G Boyle; Matthew I Milowsky; Dean F Bajorin Journal: Cancer Date: 2008-11-01 Impact factor: 6.860
Authors: H Barton Grossman; Ronald B Natale; Catherine M Tangen; V O Speights; Nicholas J Vogelzang; Donald L Trump; Ralph W deVere White; Michael F Sarosdy; David P Wood; Derek Raghavan; E David Crawford Journal: N Engl J Med Date: 2003-08-28 Impact factor: 91.245
Authors: Cheryl T Lee; Rabii Madii; Stephanie Daignault; Rodney L Dunn; Yingxi Zhang; James E Montie; David P Wood Journal: J Urol Date: 2006-04 Impact factor: 7.450
Authors: S Machele Donat; Ahmad Shabsigh; Caroline Savage; Angel M Cronin; Bernard H Bochner; Guido Dalbagni; Harry W Herr; Matthew I Milowsky Journal: Eur Urol Date: 2008-07-14 Impact factor: 20.096
Authors: Katarzyna Gronostaj; Anna Katarzyna Czech; Jakub Fronczek; Tomasz Wiatr; Mikolaj Przydacz; Przemyslaw Dudek; Lukasz Curylo; Wojciech Szczeklik; Piotr Chlosta Journal: Cent European J Urol Date: 2019-06-29
Authors: Liesbeth Demaegd; Maarten Albersen; Tim Muilwijk; Uros Milenkovic; Lisa Moris; Wouter Everaerts; Hendrik Van Poppel; Frank Van der Aa; Steven Joniau; Murat Akand Journal: Transl Androl Urol Date: 2020-12