Luca Afferi1, Chiara Lonati2,3, Francesco Montorsi4, Alberto Briganti4, Andrea Necchi5, Andrea Mari6, Andrea Minervini6, Riccardo Campi6, Ettore di Trapani7, Ottavio de Cobelli7,8, R Jeffrey Karnes9, Mohamed Ahmed9, M Carmen Mir10, Maria Asuncion Algarra10, Michael Rink11, Stefania Zamboni3, Claudio Simeone3, Wojciech Krajewski12, Evanguelos Xylinas13, Francesco Soria14, Kees Hendricksen15, Sarah Einerhand15, Agostino Mattei2, Roberto Carando2,16,17,18, Mathieu Roumiguié19, Anne Sophie Bajeot19, Peter C Black20, Shahrokh F Shariat21,22,23,24,25, Marco Moschini2,4. 1. Department of Urology, Luzerner Kantonsspital, Spitalstrasse, Luzern, Switzerland. luca.afferi@gmail.com. 2. Department of Urology, Luzerner Kantonsspital, Spitalstrasse, Luzern, Switzerland. 3. Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy. 4. Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy. 5. Department of Medical Oncology, San Raffaele Scientific Institute, Milan, Italy. 6. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. 7. Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy. 8. Department of Oncology and Hematology-Oncology, Università Degli Studi Di Milano, Milan, Italy. 9. Mayo Clinic Urology, Rochester, MN, USA. 10. Department of Urology, Foundation Instituto Valenciano Oncologia, Valencia, Spain. 11. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 12. Department of Urology and Oncologic Urology, Wrocław Medical University, Wrocław, Poland. 13. Department of Urology, Bichat-Claude Bernard Hospital, Paris University, Paris, France. 14. Division of Urology, Department of Surgical Sciences, AOU Città Della Salute E Della Scienza Di Torino, Torino School of Medicine, Torino, IT, Italy. 15. Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 16. Clinica Luganese Moncucco, Lugano, Switzerland. 17. Swiss Medical Group, Clinica Sant'Anna, Sorengo, Switzerland. 18. Clinica Santa Chiara, Locarno, Switzerland. 19. Department of Urology, CHU Toulouse-IUCT Oncopole, 31400, Toulouse, France. 20. Department of Urologic Sciences, University of British Columbia, Vancouver, Canada. 21. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. 22. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. 23. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA. 24. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 25. Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic.
Abstract
PURPOSE: To test the impact of carboplatin-based ACT on overall survival (OS) in patients with pN1-3 cM0 BCa. METHODS: A retrospective analysis was conducted on 1057 patients with pTany pN1-3 cM0 urothelial BCa treated with or without carboplatin-based ACT after radical cystectomy and bilateral lymph-node dissection between 2002 and 2018 at 12 European and North-American hospitals. No patient received neoadjuvant chemotherapy or radiation therapy. Only patients with negative surgical margins at surgery were included. A 3:1 propensity score matching (PSM) was performed using logistic regression to adjust for baseline characteristics. Univariable and multivariable Cox regression analyses were used to predict the effect of carboplatin-based ACT on OS. The Kaplan-Meier method was used to display OS in the matched cohort. RESULTS: Of the 1057 patients included in the study, 69 (6.5%) received carboplatin-based ACT. After PSM, 244 total patients were identified in two cohorts that did not differ for baseline characteristics. Death was recorded in 114 (46.7%) patients over a median follow-up of 19 months. In the multivariable Cox regression analyses, increasing age at surgery (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.01-1.06, p < 0.001) and increasing number of positive lymph nodes (HR 1.06, 95% CI 1.01-1.07, p = 0.02) were independent predictors of worse OS. The delivery of carboplatin-based ACT was not predictive of improved OS (HR 0.67, 95% CI 0.43-1.04, p = 0.08). The main limitations of this study are its retrospective design and the relatively low number of patients involved. CONCLUSIONS: Carboplatin-based might not improve OS in patients with pN1-3 cM0 BCa. Our results underline the need for alternative therapies for cisplatin-ineligible patients.
PURPOSE: To test the impact of carboplatin-based ACT on overall survival (OS) in patients with pN1-3 cM0 BCa. METHODS: A retrospective analysis was conducted on 1057 patients with pTany pN1-3 cM0 urothelial BCa treated with or without carboplatin-based ACT after radical cystectomy and bilateral lymph-node dissection between 2002 and 2018 at 12 European and North-American hospitals. No patient received neoadjuvant chemotherapy or radiation therapy. Only patients with negative surgical margins at surgery were included. A 3:1 propensity score matching (PSM) was performed using logistic regression to adjust for baseline characteristics. Univariable and multivariable Cox regression analyses were used to predict the effect of carboplatin-based ACT on OS. The Kaplan-Meier method was used to display OS in the matched cohort. RESULTS: Of the 1057 patients included in the study, 69 (6.5%) received carboplatin-based ACT. After PSM, 244 total patients were identified in two cohorts that did not differ for baseline characteristics. Death was recorded in 114 (46.7%) patients over a median follow-up of 19 months. In the multivariable Cox regression analyses, increasing age at surgery (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.01-1.06, p < 0.001) and increasing number of positive lymph nodes (HR 1.06, 95% CI 1.01-1.07, p = 0.02) were independent predictors of worse OS. The delivery of carboplatin-based ACT was not predictive of improved OS (HR 0.67, 95% CI 0.43-1.04, p = 0.08). The main limitations of this study are its retrospective design and the relatively low number of patients involved. CONCLUSIONS: Carboplatin-based might not improve OS in patients with pN1-3 cM0 BCa. Our results underline the need for alternative therapies for cisplatin-ineligible patients.
Authors: Wojciech Krajewski; Marco Moschini; Joanna Chorbińska; Łukasz Nowak; Sławomir Poletajew; Andrzej Tukiendorf; Luca Afferi; Jeremy Yuen-Chun Teoh; Tim Muilwijk; Steven Joniau; Alessandro Tafuri; Alessandro Antonelli; Francesco Cianflone; Andrea Mari; Ettore Di Trapani; Kees Hendricksen; Mario Alvarez-Maestro; Andrea Rodríguez-Serrano; Giuseppe Simone; Stefania Zamboni; Claudio Simeone; Maria Cristina Marconi; Riccardo Mastroianni; Guillaume Ploussard; Ekaterina Laukhtina; Karl Tully; Anna Kołodziej; Joanna Krajewska; Radosław Piszczek; Evanguelos Xylinas; Romuald Zdrojowy Journal: World J Urol Date: 2020-11-23 Impact factor: 4.226