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Neoadjuvant chemotherapy plus radical cystectomy versus radical cystectomy alone in clinical T2 bladder cancer without hydronephrosis
F. Soria, PC. Black, AS. Fairey, MS. Cookson, EY. Yu, W. Kassouf, MA. Dall'Era, SS. Sridhar, JS. McGrath, JL. Wright, AC. Thorpe, TM. Morgan, S. Daneshmand, JM. Holzbeierlein, TJ. Bivalacqua, S. North, DA. Barocas, Y. Lotan, P. Grivas, AJ....
Language English Country Great Britain
Document type Comparative Study, Journal Article, Multicenter Study
NLK
Free Medical Journals
from 1999
Medline Complete (EBSCOhost)
from 1999-01-01 to 1 year ago
PubMed
33152179
DOI
10.1111/bju.15289
Knihovny.cz E-resources
- MeSH
- Cystectomy * methods MeSH
- Hydronephrosis MeSH
- Cohort Studies MeSH
- Combined Modality Therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Urinary Bladder Neoplasms drug therapy pathology surgery MeSH
- Neoadjuvant Therapy * MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Neoplasm Staging MeSH
- Propensity Score MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Comparative Study MeSH
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 (
Cross Cancer Institute Edmonton AB Canada
Department of Genitourinary Oncology H Lee Moffitt Cancer Center and Research Institute Tampa FL USA
Department of Oncology University of Alberta Alberta AB Canada
Department of Surgery McGill University Health Center Montreal Canada
Department of Urologic Sciences University of British Columbia Vancouver BC Canada
Department of Urologic Surgery Vanderbilt University Medical Center Nashville TN USA
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Urology Davis Medical Center University of California at Davis Sacramento CA USA
Department of Urology Freeman Hospital Newcastle Upon Tyne UK
Department of Urology MD Anderson Cancer Center Houston TX USA
Department of Urology Medical University of Vienna Vienna General Hospital Vienna Austria
Department of Urology Stanford University School of Medicine Stanford CA USA
Department of Urology University of Kansas Medical Center Kansas City KS USA
Department of Urology University of Michigan Health System Ann Arbor MI USA
Department of Urology University of Oklahoma College of Medicine Oklahoma City OK USA
Department of Urology University of Texas Southwestern Medical Center Dallas TX USA
Department of Urology University of Washington Seattle WA USA
Department of Urology Weill Cornell Medical College Presbyterian Hospital New York NY USA
Division of Urology Department of Surgical Sciences Torino School of Medicine Torino Italy
Glickman Urological and Kidney Institute Cleveland Clinic Cleveland OH USA
Princess Margaret Hospital Toronto ON Canada
References provided by Crossref.org
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- $a Soria, Francesco $u Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
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- $a 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.
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