Abstract
Objectives: The purpose of this study was to investigate the impact of neoadjuvant chemotherapy (NAC) on perioperative morbidity and on oncological outcomes according to the type of chemotherapy regimen administered to patients with muscle-invasive bladder cancer (MIBC) who subsequently underwent radical cystectomy (RC).Methods: Data were collected retrospectively on 40 patients with bladder urothelial carcinoma who had at least two cycles of NAC, followed by RC, from 2011 to 2015 at our institution. The outcomes evaluated were NAC toxicity, perioperative complications, cancer-specific, and overall survival.Results: Among these cases, 23 patients (57.5%) received methotrexate, vinblastine, doxorubicin and cisplatin (MVAC), 4 patients (10%) received gemcitabine and cisplatin (GC), and 13 patients (32.5%) received other regimes. The early and late postoperative complication rates were 35% and 12.5%. Regarding toxicity, 85% of patients had at least one side effect of NAC, but only 21.7% discontinued therapy in the MVAC group. The pathological complete response (pCR) rates for cisplatin-based regimens (MVAC and GC) and other regimens were 44.4 and 15.4%, respectively, (p = 0.09). The pathological partial response (pPR) rates for cisplatin-based regimens and other regimens were 66.7 and 15.4%, respectively, (p = 0.002). Patients treated with a cisplatin-based chemotherapy regimen had longer overall survival than those treated with other regimen (median 38.1 vs. 18.4 months, p = 0.01).Conclusions: NAC administration was not associated with high toxicity or surgical morbidity. The pathological response rates and survival outcomes in the cisplatin-based regimens were higher than with those with non-cisplatin-based regimens. These data support the use, in patients elective to a neoadjuvant setting prior to RC for MBIC, of a cisplatin-based regimen.
Highlights
Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a high-risk of early metastasis and cancerspecific mortality
The study was designed as a retrospective investigation, in which 50 consecutive patients treated with neoadjuvant chemotherapy before undergoing radical cystectomy with bilateral pelvic lymphadenectomy at Cochin hospital from July 2011 to July 2015 were included
There were no differences between the different neoadjuvant chemotherapy (NAC) groups with regards to gender, clinical stage of tumor at diagnosis, associated CIS, histological grade of tumor, or hydronephrosis at presentation and time between last transurethral resection of bladder tumor (TURBT) and cystectomy
Summary
Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a high-risk of early metastasis and cancerspecific mortality. The gold standard treatment of MIBC is radical cystectomy (RC) in conjunction with concomitant bilateral pelvic lymphadenectomy [1]. The prognosis of these patients depends mainly on the histologically determined pathological stage of the radical cystectomy specimen (pT stage) and on the presence of lymph node metastases (pN status). 90.5% of MIBC patients undergoing radical cystectomy have a 10-year cancerspecific free survival (CSS) if the pT stage is pT0/a/is/1 pN0 (nonresidual disease or non-muscle invasive residual disease). 16.7% of patients with nodal metastasis at the time of RC have 10-year cancer-specific free survival, independent of the primary tumor stage [2]
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