Amandeep Arora1,2, Ahmed S Zugail3,4, Felipe Pugliesi3,5, Xavier Cathelineau3, Petr Macek3, Yann Barbé3, R Jeffrey Karnes6, Mohamed Ahmed6, Ettore Di Trapani7, Francesco Soria8, Mario Alvarez-Maestro9,10, Francesco Montorsi11, Alberto Briganti11, Andrea Necchi12, Benjamin Pradere13, David D'Andrea13, Wojciech Krajewski14, Mathieu Roumiguié15, Anne Sophie Bajeot15, Rodolfo Hurle16, Roberto Contieri16, Roberto Carando17, Jeremy Yuen-Chun Teoh18, Morgan Roupret19, Daniel Benamran19,20, Guillaume Ploussard21, M Carmen Mir22, Rafael Sanchez-Salas3, Marco Moschini3,11. 1. Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France. amanarora12389@gmail.com. 2. Department of Uro-Oncology, Tata Memorial Hospital, HBNI, Dr. Earnest Borges Road, Parel, Mumbai, 400012, India. amanarora12389@gmail.com. 3. Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France. 4. Department of Urology, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia. 5. Division of Urology, Men's Health Centre, Hospital Brigadeiro, São Paulo, SP, Brazil. 6. Mayo Clinic Urology, Rochester, MN, USA. 7. Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy. 8. Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Molinette Hospital, Turin, Italy. 9. Department of Urology, La Paz University Hospital, Madrid, Spain. 10. Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain. 11. Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy. 12. Department of Medical Oncology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy. 13. Department of Urology, Medical University of Vienna, Vienna, Austria. 14. Department of Urology and Oncologic Urology, Wrocław Medical University, Wrocław, Poland. 15. Department of Urology, Toulouse University Hospital, Toulouse, France. 16. IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy. 17. Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland. 18. Department of Surgery, S.H.Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China. 19. GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, 75013, Paris, France. 20. Division of Urology, Geneva University Hospitals, Geneva, Switzerland. 21. Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France. 22. Department of Urology, Foundation Instituto Valenciano Oncologia, Valencia, Spain.
Abstract
OBJECTIVE: To determine whether use of neoadjuvant chemotherapy (NAC) is associated with a higher risk of post-operative complications following radical cystectomy (RC) for bladder cancer (BCa). MATERIALS AND METHODS: We retrospectively reviewed records of patients undergoing RC for non-metastatic urothelial BCa at 13 tertiary care centres from 2007-2019. Patients who received NAC ('NAC + RC' group) were compared with those who underwent upfront RC ('RC alone' group) for intra-operative variables, incidence of post-operative complications as per the Clavien-Dindo classification (CDC) and rates of re-admission and re-intervention. Multivariable logistic regression analysis was performed to determine predictors of CDC overall and CDC major (grade III-V) complications. We also analysed the trend of NAC utilization over the study period. RESULTS: Of the 3113 patients included, 968 (31.1%) received NAC while the remaining 2145 (68.9%) underwent upfront RC for BCa. There was no significant difference between the NAC + RC and RC alone groups with regards to 30-day CDC overall (53.2% vs 54.6%, p = 0.4) and CDC major (15.5% vs 16.5%, p = 0.6) complications. The two groups were comparable for the rate of surgical re-intervention (14.6% in each group) and re-hospitalization (19.6% in NAC + RC vs 17.9% in RC alone, p = 0.2%) at 90 days. On multivariable regression analysis, NAC use was not found to be a significant predictor of 90-day CDC overall (OR 1.02, CI 0.87-1.19, p = 0.7) and CDC major (OR 1.05, CI 0.87-1.26, p = 0.6) complications. We also observed that the rate of NAC utilization increased significantly (p < 0.001) from 11.1% in 2007 to 41.2% in 2019, reaching a maximum of 48.3% in 2018. CONCLUSION: This large multicentre analysis with a substantial rate of NAC utilization showed that NAC use does not lead to an increased risk of post-operative complications following RC for BCa. This calls for increasing NAC use to allow patients to avail of its proven oncologic benefit.
OBJECTIVE: To determine whether use of neoadjuvant chemotherapy (NAC) is associated with a higher risk of post-operative complications following radical cystectomy (RC) for bladder cancer (BCa). MATERIALS AND METHODS: We retrospectively reviewed records of patients undergoing RC for non-metastatic urothelial BCa at 13 tertiary care centres from 2007-2019. Patients who received NAC ('NAC + RC' group) were compared with those who underwent upfront RC ('RC alone' group) for intra-operative variables, incidence of post-operative complications as per the Clavien-Dindo classification (CDC) and rates of re-admission and re-intervention. Multivariable logistic regression analysis was performed to determine predictors of CDC overall and CDC major (grade III-V) complications. We also analysed the trend of NAC utilization over the study period. RESULTS: Of the 3113 patients included, 968 (31.1%) received NAC while the remaining 2145 (68.9%) underwent upfront RC for BCa. There was no significant difference between the NAC + RC and RC alone groups with regards to 30-day CDC overall (53.2% vs 54.6%, p = 0.4) and CDC major (15.5% vs 16.5%, p = 0.6) complications. The two groups were comparable for the rate of surgical re-intervention (14.6% in each group) and re-hospitalization (19.6% in NAC + RC vs 17.9% in RC alone, p = 0.2%) at 90 days. On multivariable regression analysis, NAC use was not found to be a significant predictor of 90-day CDC overall (OR 1.02, CI 0.87-1.19, p = 0.7) and CDC major (OR 1.05, CI 0.87-1.26, p = 0.6) complications. We also observed that the rate of NAC utilization increased significantly (p < 0.001) from 11.1% in 2007 to 41.2% in 2019, reaching a maximum of 48.3% in 2018. CONCLUSION: This large multicentre analysis with a substantial rate of NAC utilization showed that NAC use does not lead to an increased risk of post-operative complications following RC for BCa. This calls for increasing NAC use to allow patients to avail of its proven oncologic benefit.
Authors: Giacomo Novara; James W F Catto; Timothy Wilson; Magnus Annerstedt; Kevin Chan; Declan G Murphy; Alexander Motttrie; James O Peabody; Eila C Skinner; Peter N Wiklund; Khurshid A Guru; Bertram Yuh Journal: Eur Urol Date: 2015-01-02 Impact factor: 20.096
Authors: Di Maria Jiang; Shilpa Gupta; Abhijat Kitchlu; Alejandro Meraz-Munoz; Scott A North; Nimira S Alimohamed; Normand Blais; Srikala S Sridhar Journal: Nat Rev Urol Date: 2021-01-11 Impact factor: 14.432
Authors: Paolo Dell'Oglio; Iulia Andras; David Ortega; Antonio Galfano; Walter Artibani; Riccardo Autorino; Elio Mazzone; Nicolae Crisan; Aldo Massimo Bocciardi; Rafael Sanchez-Salas; Inderbir Gill; Peter Wiklund; Mihir Desai; Dionysios Mitropoulos; Alexandre Mottrie; Giovanni E Cacciamani Journal: Eur Urol Date: 2021-05-19 Impact factor: 20.096