Neoadjuvant chemotherapy plus radical cystectomy versus radical cystectomy alone in clinical T2 bladder cancer without hydronephrosis.
#BladderCancer
#blcsm
#uroonc
#utuc
bladder cancer
clinical T2
downstaging
hydronephrosis
neoadjuvant chemotherapy
Journal
BJU international
ISSN: 1464-410X
Titre abrégé: BJU Int
Pays: England
ID NLM: 100886721
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
pubmed:
6
11
2020
medline:
15
12
2021
entrez:
5
11
2020
Statut:
ppublish
Résumé
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. 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). 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. In patients with cT2N0 BCa and no preoperative hydronephrosis, NAC increased the rate of pathological complete response and downstaging.
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
79-87Informations de copyright
© 2020 The Authors BJU International © 2020 BJU International.
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