Concomitant CIS on TURBT does not impact oncological outcomes in patients treated with neoadjuvant or induction chemotherapy followed by radical cystectomy.
Bladder cancer
Carcinoma insitu
Neoadjuvant chemotherapy
Radical cystectomy
Journal
World journal of urology
ISSN: 1433-8726
Titre abrégé: World J Urol
Pays: Germany
ID NLM: 8307716
Informations de publication
Date de publication:
Jan 2019
Jan 2019
Historique:
received:
30
03
2018
accepted:
28
05
2018
pubmed:
9
6
2018
medline:
8
6
2019
entrez:
9
6
2018
Statut:
ppublish
Résumé
Cisplatin-based neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer improves all-cause and cancer specific survival. We aimed to evaluate whether the detection of carcinoma in situ (CIS) at the time of initial transurethral resection of bladder tumor (TURBT) has an oncological impact on the response to NAC prior to radical cystectomy. Patients were identified retrospectively from 19 centers who received at least three cycles of NAC or induction chemotherapy for cT2-T4aN0-3M0 urothelial carcinoma of the bladder followed by radical cystectomy between 2000 and 2013. The primary and secondary outcomes were pathological response and overall survival, respectively. Multivariable analysis was performed to determine the independent predictive value of CIS on these outcomes. Of 1213 patients included in the analysis, 21.8% had concomitant CIS. Baseline clinical and pathologic characteristics of the 'CIS' versus 'no-CIS' groups were similar. The pathological response did not differ between the two arms when response was defined as pT0N0 (17.9% with CIS vs 21.9% without CIS; p = 0.16) which may indicate that patients with CIS may be less sensitive to NAC or ≤ pT1N0 (42.8% with CIS vs 37.8% without CIS; p = 0.15). On Cox regression model for overall survival for the cN0 cohort, the presence of CIS was not associated with survival (HR 0.86 (95% CI 0.63-1.18; p = 0.35). The presence of LVI (HR 1.41, 95% CI 1.01-1.96; p = 0.04), hydronephrosis (HR 1.63, 95% CI 1.23-2.16; p = 0.001) and use of chemotherapy other than ddMVAC (HR 0.57, 95% CI 0.34-0.94; p = 0.03) were associated with shorter overall survival. For the whole cohort, the presence of CIS was also not associated with survival (HR 1.05 (95% CI 0.82-1.35; p = 0.70). In this multicenter, real-world cohort, CIS status at TURBT did not affect pathologic response to neoadjuvant or induction chemotherapy. This study is limited by its retrospective nature as well as variability in chemotherapy regimens and surveillance regimens.
Sections du résumé
BACKGROUND
BACKGROUND
Cisplatin-based neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer improves all-cause and cancer specific survival. We aimed to evaluate whether the detection of carcinoma in situ (CIS) at the time of initial transurethral resection of bladder tumor (TURBT) has an oncological impact on the response to NAC prior to radical cystectomy.
PATIENTS AND METHODS
METHODS
Patients were identified retrospectively from 19 centers who received at least three cycles of NAC or induction chemotherapy for cT2-T4aN0-3M0 urothelial carcinoma of the bladder followed by radical cystectomy between 2000 and 2013. The primary and secondary outcomes were pathological response and overall survival, respectively. Multivariable analysis was performed to determine the independent predictive value of CIS on these outcomes.
RESULTS
RESULTS
Of 1213 patients included in the analysis, 21.8% had concomitant CIS. Baseline clinical and pathologic characteristics of the 'CIS' versus 'no-CIS' groups were similar. The pathological response did not differ between the two arms when response was defined as pT0N0 (17.9% with CIS vs 21.9% without CIS; p = 0.16) which may indicate that patients with CIS may be less sensitive to NAC or ≤ pT1N0 (42.8% with CIS vs 37.8% without CIS; p = 0.15). On Cox regression model for overall survival for the cN0 cohort, the presence of CIS was not associated with survival (HR 0.86 (95% CI 0.63-1.18; p = 0.35). The presence of LVI (HR 1.41, 95% CI 1.01-1.96; p = 0.04), hydronephrosis (HR 1.63, 95% CI 1.23-2.16; p = 0.001) and use of chemotherapy other than ddMVAC (HR 0.57, 95% CI 0.34-0.94; p = 0.03) were associated with shorter overall survival. For the whole cohort, the presence of CIS was also not associated with survival (HR 1.05 (95% CI 0.82-1.35; p = 0.70).
CONCLUSION
CONCLUSIONS
In this multicenter, real-world cohort, CIS status at TURBT did not affect pathologic response to neoadjuvant or induction chemotherapy. This study is limited by its retrospective nature as well as variability in chemotherapy regimens and surveillance regimens.
Identifiants
pubmed: 29882105
doi: 10.1007/s00345-018-2361-0
pii: 10.1007/s00345-018-2361-0
doi:
Substances chimiques
Antineoplastic Agents
0
Cisplatin
Q20Q21Q62J
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
165-172Références
Eur Urol Focus. 2018 Sep;4(5):720-724
pubmed: 28753837
J Urol. 2016 Apr;195(4 Pt 1):886-93
pubmed: 26521718
J Urol. 2009 Dec;182(6):2632-7
pubmed: 19836794
Cancer Cell. 2004 Aug;6(2):111-6
pubmed: 15324694
Int J Urol. 2012 Mar;19(3):229-33
pubmed: 22121922
Int Urol Nephrol. 2004;36(1):41-4
pubmed: 15338671
Urol Oncol. 2018 Sep;36(9):413-422
pubmed: 29128420
Eur Urol. 2015 Feb;67(2):241-9
pubmed: 25257030
Clin Genitourin Cancer. 2017 Aug;15(4):479-486
pubmed: 28040424
JAMA Oncol. 2016 Aug 1;2(8):1094-6
pubmed: 27310333
Urol Oncol. 2014 Nov;32(8):1108-15
pubmed: 25443274
J Urol. 2010 Jul;184(1):74-80
pubmed: 20546806
Cancer Cell. 2014 Feb 10;25(2):152-65
pubmed: 24525232
J Urol. 2015 May;193(5):1494-9
pubmed: 25451834
Cancer. 2009 Feb 15;115(4):792-9
pubmed: 19127557
Eur Urol. 2017 Sep;72(3):354-365
pubmed: 28365159
Cancer Discov. 2014 Oct;4(10):1140-53
pubmed: 25096233
Eur Urol. 2015 Dec;68(6):959-67
pubmed: 26238431
Nat Rev Cancer. 2015 Jan;15(1):25-41
pubmed: 25533674
N Engl J Med. 2003 Aug 28;349(9):859-66
pubmed: 12944571