Preoperative chemotherapy for prostatic stromal invasive urothelial bladder cancer: comparison of oncological outcomes of male patients with cT4a disease undergoing radical cystectomy with or without preoperative chemotherapy

Abstract

Background: The value of preoperative chemotherapy to prostatic stromal invasive urothelial bladder cancer remains uncertain. This study presented the pathological response and oncological outcomes of male patients with cT4a urothelial bladder cancer managed with preoperative chemotherapy followed by radical cystectomy.Materials and methods: Data were collected retrospectively from male patients with cT4a urothelial bladder cancer, who underwent radical cystectomy with or without preoperative chemotherapy. Patient characteristics and pathological response were compared. The Kaplan-Meier method and multivariable Cox regression were used to analyze recurrence-free survival and overall survival.Results: From 1989 to 2016, 90 male patients with primary cT4a urothelial bladder cancer underwent radical cystectomy at the institution, 55 (61%) did not have preoperative chemotherapy and 35 (39%) had preoperative chemotherapy. The preoperative chemotherapy group had more lymphovascular invasion on primary transurethral resection of bladder tumor (31.4% vs 18.2%, p = .2) and more clinically positive nodal disease (31.4% vs 10.9%, p = .09). At radical cystectomy, the preoperative chemotherapy group had more tumor down staging (60% vs 29.1%, p = .005), less lymphovascular invasion (40% vs 54.5%, p = .05) and less positive nodal disease (25.7% vs 45.5%, p = .006). Hydronephrosis, lymphovascular invasion and age >70 were associated with worse recurrence-free survival and overall survival (p < .05). Tumor down-staging was associated with improved recurrence-free survival and overall survival (p = .003, p = .03, respectively). Preoperative chemotherapy alone was not associated with improved oncologic outcomes.Conclusions: Preoperative chemotherapy is associated with cT4a bladder cancer down-staging, decreased lymphovascular invasion and decreased positive nodal disease. Preoperative chemotherapy provides survival benefit to those who achieved pathological response.