Francesco Soria1, Peter C Black2, Adrian S Fairey3, Michael S Cookson4, Evan Y Yu5, Wassim Kassouf6, Marc A Dall'Era7, Srikala S Sridhar8, John S McGrath9, Jonathan L Wright10, Andrew C Thorpe11, Todd M Morgan12, Siamak Daneshmand13, Jeff M Holzbeierlein14, Trinity J Bivalacqua15, Scott North16,17, Daniel A Barocas18, Yair Lotan19, Petros Grivas5,20, Andrew J Stephenson21, Jay B Shah22,23, Bas W van Rhijn24, Philippe E Spiess25, Shahrokh F Shariat19,26,27,28,29,30, Paolo Gontero1. 1. Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy. 2. Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada. 3. University of Alberta, Edmonton, AB, Canada. 4. Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA. 5. Department of Medicine, Division of Oncology, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 6. Department of Surgery (Division of Urology), McGill University Health Center, Montreal, Canada. 7. Department of Urology, Davis Medical Center, University of California at Davis, Sacramento, CA, USA. 8. Princess Margaret Hospital, Toronto, ON, Canada. 9. Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK. 10. Department of Urology, University of Washington, Seattle, WA, USA. 11. Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK. 12. Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA. 13. USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA. 14. Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA. 15. Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA. 16. Cross Cancer Institute, Edmonton, AB, Canada. 17. Department of Oncology, University of Alberta, Alberta, AB, Canada. 18. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 19. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 20. Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA. 21. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. 22. Department of Urology, Stanford University School of Medicine, Stanford, CA, USA. 23. Department of Urology, MD Anderson Cancer Center, Houston, TX, USA. 24. Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 25. Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. 26. Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, NY, USA. 27. Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. 28. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic. 29. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. 30. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
Abstract
OBJECTIVES: To assess the efficacy of neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) in a retrospective multicentre cohort of patients with cT2N0M0 bladder cancer (BCa) without preoperative hydronephrosis. PATIENTS AND METHODS: This was a propensity-based analysis of 619 patients. Of these, 316 were treated with NAC followed by RC and 303 with upfront RC. After multiple imputations, inverse probability of treatment weighting (IPTW) was used to account for potential selection bias. Multivariable logistic regression analysis was performed to evaluate the impact of NAC on pathological complete response and downstaging at RC, while IPTW-adjusted Kaplan-Meier curves and Cox regression models were built to evaluate the impact of NAC on overall survival (OS). RESULTS: After IPTW-adjusted analysis, standardised differences between groups were <15%. A complete response (pT0N0) at final pathology was achieved in 94 (30%) patients receiving NAC and nine (3%) undergoing upfront RC. Downstaging to non-muscle-invasive disease (<pT2N0M0) was observed in 174 (55%) patients after NAC and in 72 (24%) without NAC. On multivariable analysis, NAC was found to be an independent predictor of both pathological complete response and downstaging. No significant difference with respect to OS was observed between groups with a median follow-up of 18 months. CONCLUSIONS: In patients with cT2N0 BCa and no preoperative hydronephrosis, NAC increased the rate of pathological complete response and downstaging.
OBJECTIVES: To assess the efficacy of neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) in a retrospective multicentre cohort of patients with cT2N0M0 bladder cancer (BCa) without preoperative hydronephrosis. PATIENTS AND METHODS: This was a propensity-based analysis of 619 patients. Of these, 316 were treated with NAC followed by RC and 303 with upfront RC. After multiple imputations, inverse probability of treatment weighting (IPTW) was used to account for potential selection bias. Multivariable logistic regression analysis was performed to evaluate the impact of NAC on pathological complete response and downstaging at RC, while IPTW-adjusted Kaplan-Meier curves and Cox regression models were built to evaluate the impact of NAC on overall survival (OS). RESULTS: After IPTW-adjusted analysis, standardised differences between groups were <15%. A complete response (pT0N0) at final pathology was achieved in 94 (30%) patients receiving NAC and nine (3%) undergoing upfront RC. Downstaging to non-muscle-invasive disease (<pT2N0M0) was observed in 174 (55%) patients after NAC and in 72 (24%) without NAC. On multivariable analysis, NAC was found to be an independent predictor of both pathological complete response and downstaging. No significant difference with respect to OS was observed between groups with a median follow-up of 18 months. CONCLUSIONS: In patients with cT2N0 BCa and no preoperative hydronephrosis, NAC increased the rate of pathological complete response and downstaging.
Authors: David D'Andrea; Shahrokh F Shariat; Francesco Soria; Andrea Mari; Laura S Mertens; Ettore Di Trapani; Diego M Carrion; Benjamin Pradere; Renate Pichler; Ronan Filippot; Guillaume Grisay; Francesco Del Giudice; Ekaterina Laukhtina; David Paulnsteiner; Wojciech Krajewski; Sonia Vallet; Martina Maggi; Ettore De Berardinis; Mario Álvarez-Maestro; Stephan Brönimann; Fabrizio Di Maida; Bas W G van Rhijn; Kees Hendricksen; Marco Moschini Journal: Eur Urol Open Sci Date: 2022-05-28
Authors: Dong Hyuk Kang; Kang Su Cho; Young Joon Moon; Doo Yong Chung; Hae Do Jung; Joo Yong Lee Journal: PLoS One Date: 2022-04-21 Impact factor: 3.240