Abstract
Background: Response to neoadjuvant chemotherapy (NACT) has been proven to be an established prognostic factor after open radical cystectomy (ORC). We evaluated the impact of NACT on survival outcomes of a single-institution robotic radical cystectomy (RARC) series. Methods: From January 2012 to June 2020, 79 patients were identified. Baseline, demographic, perioperative, and pathologic data were described. Kaplan–Meier with the log-rank test was used to compare overall survival (OS) differences between complete, partial, and no-NACT responders, respectively. Univariable and multivariable regression analyses were performed to identify predictors of OS. Results: Complete, partial, and absent response to NACT were recorded in 43 (54.4%), 21 (19%), and 15 (26.6%) patients, respectively. A complete response to NACT displayed a trend toward significant higher OS (p = 0.03). In univariable analysis, significant predictors of lower OS were hypertension (HR 3.37; CI 95% 1.31–8.62; p = 0.01); advanced nodal involvement (HR 2.41; CI 95% 0.53–10.9; p < 0.001); and incomplete response to NACT (HR 0.41; CI 95% 0.18–0.95; p = 0.039). In multivariable analysis, the only independent predictor of worse OS was advanced pathologic N stages (HR 10.1; CI: 95% CI 2.3–44.3; p = 0.002). Conclusions: Complete response to NACT is associated with increased OS probability, but significant nodal residual disease remains the only independent predictor of OS after RARC.
Highlights
Radical cystectomy (RC) with pelvic lymph node dissection represents the standard of care for patients with muscle-invasive urothelial bladder cancer (MIBC), recurrent, or Bacillus Calmette-Guerin (BCG)-refractory non-muscle-invasive high-grade urothelial carcinoma (UC) [1]
We evaluated the impact of neoadjuvant chemotherapy (NACT) on survival outcomes of a single-institution robotic radical cystectomy (RARC) series
Patients were categorized according to NACT using the Response Evaluation Criteria in Solid Tumors V 1.1 (RECIST V.1.1) guidelines in three groups: complete responders, partial responders, and the non-responders group [15]
Summary
Radical cystectomy (RC) with pelvic lymph node dissection represents the standard of care for patients with muscle-invasive urothelial bladder cancer (MIBC), recurrent, or Bacillus Calmette-Guerin (BCG)-refractory non-muscle-invasive high-grade UC [1]. Since response to guideline-driven neoadjuvant regimens has been proven to be an established prognostic factor after open radical cystectomy (ORC), data reported on this issue in the era of robotic radical cystectomy (RARC) are scanty and limited to multicentric series [10,11]. In this context, we sought to evaluate the impact of NACT on perioperative and survival outcomes of RARC at a single high-volume institution. Conclusions: Complete response to NACT is associated with increased OS probability, but significant nodal residual disease remains the only independent predictor of OS after RARC
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