Selecting the Best Candidates for Cisplatin-based Adjuvant Chemotherapy After Radical Cystectomy Among Patients with pN+ Bladder Cancer
Language English Country Netherlands Media print-electronic
Document type Multicenter Study, Journal Article
PubMed
35715319
DOI
10.1016/j.euo.2022.04.001
PII: S2588-9311(22)00062-1
Knihovny.cz E-resources
- Keywords
- Adjuvant chemotherapy, Bladder cancer, Cisplatin, Nodal metastases, Radical cystectomy, Urothelial cancer,
- MeSH
- Chemotherapy, Adjuvant MeSH
- Cisplatin therapeutic use MeSH
- Cystectomy * adverse effects MeSH
- Humans MeSH
- Urinary Bladder pathology MeSH
- Urinary Bladder Neoplasms * drug therapy surgery pathology MeSH
- Retrospective Studies MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Names of Substances
- Cisplatin MeSH
A trend towards greater benefit from adjuvant chemotherapy (ACT) in pN+ bladder cancer (BCa) has been observed in multiple randomized controlled trials. However, it is still unclear which patients might benefit the most from this approach. We retrospectively analyzed a multicenter cohort of 1381 patients with pTany pN1-3 cM0 R0 urothelial BCa treated with radical cystectomy (RC) with or without cisplatin-based ACT. The main endpoint was overall survival (OS) after RC. We performed 1:1 propensity score matching to adjust for baseline characteristics and conducted a classification and regression tree (CART) analysis to assess postoperative risk groups and Cox regression analyses to predict OS. Overall, 391 patients (28%) received cisplatin-based ACT. After matching, two cohorts of 281 patients with pN+ BCa were obtained. CART analysis stratified patients into three risk groups: favorable prognosis (≤pT2 and positive lymph node [PLN] count ≤2; odds ratio [OR] 0.43), intermediate prognosis (≥pT3 and PLN count ≤2; OR 0.92), and poor prognosis (pTany and PLN count ≥3; OR 1.36). Only patients with poor prognosis benefitted from ACT in terms of OS (HR 0.51; p < 0.001). We created the first algorithm that stratifies patients with pN+ BCa into prognostic classes and identified patients with pTany BCa with PLN ≥3 as the most suitable candidates for cisplatin-based ACT. PATIENT SUMMARY: We found that overall survival among patients with bladder cancer and evidence of lymph node involvement depends on cancer stage and the number of positive lymph nodes. Patients with more than three nodes affected by metastases seem to experience the greatest overall survival benefit from cisplatin-based chemotherapy after bladder removal. Our study suggests that patients with the highest risk should be prioritized for cisplatin-based chemotherapy after bladder removal.
Department of Experimental and Clinical Medicine University of Florence Florence Italy
Department of Medical Oncology San Raffaele Scientific Institute Milan Italy
Department of Surgical and Diagnostic Integrated Sciences University of Genova Genova Italy
Department of Urologic Science University of British Columbia Vancouver BC Canada
Department of Urology and Oncologic Urology Wrocław Medical University Wrocław Poland
Department of Urology Bichat Claude Bernard Hospital Paris University Paris France
Department of Urology CHU Toulouse IUCT Oncopole Toulouse France
Department of Urology European Institute of Oncology IRCCS Milan Italy
Department of Urology Foundation Instituto Valenciano Oncologia Valencia Spain
Department of Urology Institut Mutualiste Montsouris and Université Paris Descartes Paris France
Department of Urology Luzerner Kantonsspital Lucerne Switzerland
Department of Urology Mayo Clinic Rochester MN USA
Department of Urology München Klinik Bogenhausen Munich Germany
Department of Urology Ruhr University Bochum Marien Hospital Herne Germany
Department of Urology Spedali Civili Hospital University of Brescia Brescia Italy
Department of Urology University Hospital Zürich University of Zürich Zürich Switzerland
Department of Urology University Medical Center Hamburg Eppendorf Hamburg Germany
Department of Urology University of Verona Verona Italy
Department of Urology Urological Research Institute San Raffaele Scientific Institute Milan Italy
S H Ho Urology Department of Surgery The Chinese University of Hong Kong Hong Kong China
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