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Impact of Adjuvant Chemotherapy on Survival of Patients with Advanced Residual Disease at Radical Cystectomy following Neoadjuvant Chemotherapy: Systematic Review and Meta-Analysis
W. Krajewski, Ł. Nowak, M. Moschini, S. Poletajew, J. Chorbińska, A. Necchi, F. Montorsi, A. Briganti, R. Sanchez-Salas, SF. Shariat, J. Palou, M. Babjuk, JY. Teoh, F. Soria, B. Pradere, PI. Ornaghi, A. Pawlak, J. Dembowski, R. Zdrojowy
Jazyk angličtina Země Švýcarsko
Typ dokumentu časopisecké články, přehledy
NLK
Free Medical Journals
od 2012
PubMed Central
od 2012
Europe PubMed Central
od 2012
ProQuest Central
od 2019-01-01
Open Access Digital Library
od 2012-01-01
Open Access Digital Library
od 2012-01-01
Health & Medicine (ProQuest)
od 2019-01-01
ROAD: Directory of Open Access Scholarly Resources
od 2012
PubMed
33567656
DOI
10.3390/jcm10040651
Knihovny.cz E-zdroje
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) with pelvic lymph-node dissection is the standard treatment for cT2-4a cN0 cM0 muscle-invasive bladder cancer (MIBC). Despite the significant improvement of primary-tumor downstaging with NAC, up to 50% of patients are eventually found to have advanced residual disease (pT3-T4 and/or histopathologically confirmed nodal metastases (pN+)) at RC. Currently, there is no established standard of care in such cases. The aim of this systematic review and meta-analysis was to assess differences in survival rates between patients with pT3-T4 and/or pN+ MIBC who received NAC and surgery followed by adjuvant chemotherapy (AC), and patients without AC. MATERIALS AND METHODS: A systematic search was conducted in accordance with the PRISMA statement using the Medline, Embase, and Cochrane Library databases. The last search was performed on 12 November 2020. The primary end point was overall survival (OS) and the secondary end point was disease-specific survival (DSS). RESULTS: We identified 2124 articles, of which 6 were selected for qualitative and quantitative analyses. Of a total of 3096 participants in the included articles, 2355 (76.1%) were in the surveillance group and 741 (23.9%) received AC. The use of AC was associated with significantly better OS (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.75-0.94; p = 0.002) and DSS (HR 0.56, 95% CI 0.32-0.99; p = 0.05). Contrary to the main analysis, in the subgroup analysis including only patients with pN+, AC was not significantly associated with better OS compared to the surveillance group (HR 0.89, 95% CI 0.58-1.35; p = 0.58). CONCLUSIONS: The administration of AC in patients with MIBC and pT3-T4 residual disease after NAC might have a positive impact on OS and DSS. However, this may not apply to N+ patients.
2nd Department of Urology Centre of Postgraduate Medical Education 01 813 Warsaw Poland
Department of Medical Oncology Fondazione IRCCS Istituto Nazionale dei Tumori 20133 Milan Italy
Department of Oncology and Urology University Hospital of Tours 37000 Tours France
Department of Urology and Oncologic Urology Wrocław Medical University 50 556 Wroclaw Poland
Department of Urology Institute Mutualiste Montsouris Université Paris Descartes 75014 Paris France
Department of Urology Medical University of Vienna 1090 Vienna Austria
Department of Urology University of Texas Southwestern Medical Center Dallas TX 75390 USA
Departments of Urology Weill Cornell Medical College New York NY 10065 USA
European Association of Urology Research Foundation 6803 AA Arnhem The Netherlands
Fundació Puigvert Department of Urology Autonomous University of Barcelona 08025 Barcelona Spain
Klinik für Urologie Luzerner Kantonsspital 6004 Lucerne Switzerland
Unit of Urology Urological Research Institute IRCCS Ospedale San Raffaele 20132 Milan Italy
Citace poskytuje Crossref.org
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- $a Krajewski, Wojciech $u Department of Urology and Oncologic Urology, Wrocław Medical University, 50-556 Wroclaw, Poland
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- $a BACKGROUND: Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) with pelvic lymph-node dissection is the standard treatment for cT2-4a cN0 cM0 muscle-invasive bladder cancer (MIBC). Despite the significant improvement of primary-tumor downstaging with NAC, up to 50% of patients are eventually found to have advanced residual disease (pT3-T4 and/or histopathologically confirmed nodal metastases (pN+)) at RC. Currently, there is no established standard of care in such cases. The aim of this systematic review and meta-analysis was to assess differences in survival rates between patients with pT3-T4 and/or pN+ MIBC who received NAC and surgery followed by adjuvant chemotherapy (AC), and patients without AC. MATERIALS AND METHODS: A systematic search was conducted in accordance with the PRISMA statement using the Medline, Embase, and Cochrane Library databases. The last search was performed on 12 November 2020. The primary end point was overall survival (OS) and the secondary end point was disease-specific survival (DSS). RESULTS: We identified 2124 articles, of which 6 were selected for qualitative and quantitative analyses. Of a total of 3096 participants in the included articles, 2355 (76.1%) were in the surveillance group and 741 (23.9%) received AC. The use of AC was associated with significantly better OS (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.75-0.94; p = 0.002) and DSS (HR 0.56, 95% CI 0.32-0.99; p = 0.05). Contrary to the main analysis, in the subgroup analysis including only patients with pN+, AC was not significantly associated with better OS compared to the surveillance group (HR 0.89, 95% CI 0.58-1.35; p = 0.58). CONCLUSIONS: The administration of AC in patients with MIBC and pT3-T4 residual disease after NAC might have a positive impact on OS and DSS. However, this may not apply to N+ patients.
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