INTRODUCTION: We assessed the differential performance of imaging modalities predicting pathological response to neoadjuvant chemotherapy (NAC) in urothelial bladder cancer (UBC). MATERIAL AND METHODS: Literature search was conducted using the MEDLINE, SCOPUS, and Cochrane Library in December 2023 to identify eligible studies. RESULTS: Twenty-two studies comprising 1085 patients were selected. The pooled diagnostic odds ratio (DOR), positive likelihood ratio (LR), and negative LR of FDG positron emission tomography-computed tomography (PET/CT) for predicting bladder tumor complete pathological response (CPR) were 17.33 (95% CI: 1.65-180.99), 2.80 (95% CI: 1.04-7.57), and 0.16 (95% CI: 0.02-0.90), respectively. The pooled DOR, positive LR, and negative LR of FDG- PET/CT for predicting lymph node CPR were 5.25 (95% CI: 2.77-9.93), 1.62 (95% CI: 1.20-2.19), and 0.30 (95% CI: 0.22-0.43), respectively. The pooled DOR, positive LR, and negative LR of contrast enhanced magnetic resonance imaging (CEMRI) for predicting bladder tumor CPR were 153 (95% CI: 26.29-890.1), 16.20 (95% CI: 4.19-62.54), and 0.10 (95% CI: 0.04-0.26), respectively. The pooled DOR, positive LR, and negative LR of CEMRI for predicting lymph node CPR were 13.33 (95% CI: 1.06-166.37), 5.62 (95% CI: 0.82-38.53), and 0.42 (95% CI: 0.16-1.06), respectively. CONCLUSIONS: We demonstrated that CEMRI (including mpMRI) helps accurate assessment of response to NAC in UBC. While CEMRI is a useful tool to detect residual tumor in lymph nodes, contrast enhanced CT scan and FDG-PET/CT are precise staging modality to identify nodal metastasis responders to NAC. Nevertheless, this differential diagnostic performance needs to be further refined with radiomics and novel tracers to help individualized clinical decision-making.

Collegium Medicum Faculty of Medicine WSB University Dąbrowa Górnicza Poland

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Urology Jikei University School of Medicine Tokyo Japan

Department of Urology Semmelweis University Budapest Hungary

Department of Urology Shariati Hospital Tehran University of Medical Sciences Tehran Iran

Department of Urology Shimane University Faculty of Medicine Shimane Japan

Department of Urology The James Buchanan Brady Urological Institute The Johns Hopkins University School of Medicine Baltimore MD United States of America

Department of Urology University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Urology University of Texas Southwestern Medical Center Dallas United States of America

Departments of Urology Weill Cornell Medical College New York United States of America

Division of Urology Department of Special Surgery Jordan University Hospital The University of Jordan Amman Jordan

Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia

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Zargar H, Shah JB, van Rhijn BW, et al. . Neoadjuvant Dose Dense MVAC versus Gemcitabine and Cisplatin in Patients with cT3–4aN0M0 Bladder Cancer Treated with Radical Cystectomy. J Urol. 2018; 199: 1452–1458. PubMed

D’Andrea D, Black PC, Zargar H, et al. . Identifying the Optimal Number of Neoadjuvant Chemotherapy Cycles in Patients with Muscle Invasive Bladder Cancer. J Urol. 2022; 207: 70–76. PubMed

Alfred Witjes J, Max Bruins H, Carrión A, et al. . European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2023 Guidelines. Eur Urol. 2024; 85: 17–31. PubMed

Grossmann NC, Rajwa P, Quhal F, et al. . Comparative Outcomes of Primary Versus Recurrent High-risk Non–muscle-invasive and Primary Versus Secondary Muscle-invasive Bladder Cancer After Radical Cystectomy: Results from a Retrospective Multicenter Study. Eur Urol Open Sci. 2022; 39: 14–21. PubMed PMC

Moschini M, Soria F, Klatte T, et al. . Validation of Preoperative Risk Grouping of the Selection of Patients Most Likely to Benefit From Neoadjuvant Chemotherapy Before Radical Cystectomy. Clin Genitourin Cancer. 2017; 15: e267-e273. PubMed

Vale CL. Neoadjuvant chemotherapy in invasive bladder cancer: Update of a systematic review and meta-analysis of individual patient data. Eur Urol. 2005; 48: 202–206. PubMed

Shariat SF, Zlotta AR, Ashfaq R, et al. . Cooperative effect of cell-cycle regulators expression on bladder cancer development and biologic aggressiveness. Modern Pathology. 2007; 20: 445–459. PubMed

Ploussard G, Shariat SF, Dragomir A, et al. . Conditional survival after radical cystectomy for bladder cancer: Evidence for a patient changing risk profile over time. Eur Urol. 2014; 66: 361–370. PubMed

Shariat SF, Lotan Y, Vickers A, et al. . Statistical consideration for clinical biomarker research in bladder cancer. Urol Oncol. 2010; 28: 389–400. PubMed PMC

Meeks JJ, Al-Ahmadie H, Faltas BM, et al. . Genomic heterogeneity in bladder cancer: challenges and possible solutions to improve outcomes. Nat Rev Urol. 2020; 17: 259–270. PubMed PMC

Panebianco V, Briganti A, Boellaard TN, et al. . Clinical application of bladder MRI and the Vesical Imaging-Reporting And Data System. Nat Rev Urol. 2024; 21: 243–251. PubMed

Muin D, Laukhtina E, Hacker M, et al. . PET in bladder cancer imaging. Curr Opin Urol. 2023; 33: 206–210. PubMed

Magers MJ, Kaimakliotis HZ, Barboza MP, et al. . Clinicopathological characteristics of ypT0N0 urothelial carcinoma following neoadjuvant chemotherapy and cystectomy. J Clin Pathol. 2019; 72: 550–553. PubMed

Bertolaso P, Brouste V, Cazeau A-L, et al. . Impact of 18 FDG- PET CT in the Management of Muscle Invasive Bladder Cancer. Clin Genitourin Cancer. 2022; 20: 297–297.e6. PubMed

Barentsz JO, Berger-Hartog O, Witjes JA, et al. . Evaluation of chemotherapy in advanced urinary bladder cancer with fast dynamic contrast-enhanced MR imaging. Radiology. 1998; 207: 791–797. PubMed

van de Putte EEF, Vegt E, Mertens LS, et al. . FDG-PET/CT for response evaluation of invasive bladder cancer following neoadjuvant chemotherapy. Int Urol Nephrol. 2017; 49: 1585–1591. PubMed

Salminen A, Jambor I, Merisaari H, et al. . 11C-acetate PET/MRI in bladder cancer staging and treatment response evaluation to neoadjuvant chemotherapy: A prospective multicenter study (ACEBIB trial). Cancer Imaging. 2018; 18: 25. PubMed PMC

Liberati A, Altman DG, Tetzlaff J, et al. . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Med. 2009; 62:e1–34. PubMed

Whiting PF, Rutjes AWS, Westwood ME, et al. . Quadas-2: A revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011; 155: 529–536. PubMed

Plana MN, Arevalo-Rodriguez I, Fernández-García S, et al. . Meta-DiSc 2.0: a web application for meta-analysis of diagnostic test accuracy data. BMC Med Res Methodol. 2022; 22: 306. PubMed PMC

Schrier BPh, Peters M, Barentsz JO, et al. . Evaluation of chemotherapy with magnetic resonance imaging in patients with regionally metastatic or unresectable bladder cancer. Eur Urol. 2006; 49: 698–703. PubMed

Donaldson SB, Bonington SC, Kershaw LE, et al. . Dynamic contrast-enhanced MRI in patients with muscle-invasivetransitional cell carcinoma of the bladder can distinguish between residual tumour and post-chemotherapy effect. Eur J Radiol. 2013; 82: 2161–2168. PubMed

Nguyen HT, Jia G, Shah ZK, et al. . Prediction of chemotherapeutic response in bladder cancer using K-means clustering of dynamic contrast-enhanced (DCE)-MRI pharmacokinetic parameters. J Magn Reson Imaging. 2015; 41: 1374–1382. PubMed PMC

Pecoraro M, Del Giudice F, Magliocca F, et al. . Vesical Imaging-Reporting and Data System (VI-RADS) for assessment of response to systemic therapy for bladder cancer: preliminary report. Abdom Radiol. 2022; 47: 763–770. PubMed

Yang X, Yuan B, Zhang Y, et al. . Quantitative multiparametric MRI as a promising tool for the assessment of early response to neoadjuvant chemotherapy in bladder cancer. Eur J Radiol. 2022; 157: 110587. PubMed

Ahmed SA, Taher MGA, Ali WA, et al. . Diagnostic performance of contrast-enhanced dynamic and diffusion-weighted MR imaging in the assessment of tumor response to neoadjuvant therapy in muscle-invasive bladder cancer. Abdom Radiol. 2021; 46: 2712–2721. PubMed

Nishimura K, Fujiyama C, Nakashima K, et al. . The effects of neoadjuvant chemotherapy and chemo-radiation therapy on MRI staging in invasive bladder cancer: Comparative study based on the pathological examination of whole layer bladder wall. Int Urol Nephrol. 2009; 41: 869–875. PubMed

Mertens LS, Fioole-Bruining A, Van Rhijn BWG, et al. . FDG-positron emission tomography/computerized tomography for monitoring the response of pelvic lymph node metastasis to neoadjuvant chemotherapy for bladder cancer. J Urol. 2013; 189: 1687–1691. PubMed

Kollberg P, Almquist H, Bläckberg M, et al. . [18F]Fluorodeoxyglucose-positron emission tomography/computed tomography response evaluation can predict histological response at surgery after induction chemotherapy for oligometastatic bladder cancer. Scand J Urol. 2017; 51: 308–313. PubMed

Jakse G, Zur Nedden D, Hellweg G, et al. . Evaluation of tumor response in patients with bladder cancer undergoing combined radiotherapy and chemotherapy. Eur Urol. 1990; 17: 286–288. PubMed

Hadjiiski L, Weizer AZ, Alva A, et al. . Treatment response assessment for bladder cancer on CT based on computerized volume analysis, world health organization criteria, and RECIST. AJR Am J Roentgenol. 2015; 205: 348–352. PubMed PMC

Cha KH, Hadjiiski L.M. P, Cohan R.H. MD, et al. . Diagnostic Accuracy of CT for Prediction of Bladder Cancer Treatment Response with and without Computerized Decision Support. Acad Radiol. 2019; 26: 1137–1145. PubMed PMC

Choi SJ, Park KJ, Lee G, et al. . Urothelial phase CT for assessment of pathologic complete response after neoadjuvant chemotherapy in muscle-invasive bladder cancer. Eur J Radiol. 126:108902. PubMed

Wu E, Hadjiiski LM, Samala RK, et al. . Deep learning approach for assessment of bladder cancer treatment response. Tomography. 2019; 5: 201–208. PubMed PMC

Soubra A, Gencturk M, Froelich J, et al. . FDG-PET/CT for Assessing the Response to Neoadjuvant Chemotherapy in Bladder Cancer Patients. Clin Genitourin Cancer. 2018; 16: 360–364. PubMed

Ghodoussipour S, Xu W, Tran K, et al. . Preoperative chemotherapy in clinically node positive muscle invasive bladder cancer: Radiologic variables can predict response. Urol Oncol. 2021; 39: 133.e1–133.e8. PubMed

Fitoussi O, Roche JB, Riviere J, et al. . Accuracy of FDG-PET/CT for Response Evaluation of Muscle-Invasive Bladder Cancer following Neoadjuvant or Induction Chemotherapy. Urol Int. 2023; 107: 239–245. PubMed

Hadjiiski LM, Cha KH, Cohan RH, et al. . Intraobserver variability in bladder cancer treatment response assessment with and without computerized decision support. Tomography. 2020; 6: 194–202. PubMed PMC

Wang X, Jemaa S, Fredrickson J, et al. . Heart and bladder detection and segmentation on FDG PET/CT by deep learning. BMC Med Imaging. 2022; 22: 58. PubMed PMC

Tariq A, McCart Reed AE, Morton A, et al. . Urothelial Carcinoma and Prostate-specific Membrane Antigen: Cellular, Imaging, and Prognostic Implications. Eur Urol Focus. 2022; 8: 1256–1269. PubMed

Tumedei MM, Ravaioli S, Matteucci F, et al. . Spotlight on PSMA as a new theranostic biomarker for bladder cancer. Sci Rep. 2021; 11: 9777. PubMed PMC