The long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy combined with radical cystectomy versus radical cystectomy alone for bladder cancer: a propensity-score matching study

Wasilijiang Wahafu,Feiya Yang,Liming Song,Wenbin Xu,Mengtong Wang,Mingshuai Wang,Qingbao He,Lin Hua,Yinong Niu,Nianzeng Xing,Sai Liu

doi:10.1186/s12894-019-0552-7

Abstract

BackgroundBladder cancer is a complex disease associated with high morbidity and mortality. Management of bladder cancer before radical cystectomy continues to be controversial. We compared the long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy (IAC) versus no IAC (NIAC) before radical cystectomy (RC) for bladder cancer.MethodsWe performed a retrospective review of patients who underwent either one-shot IAC or NIAC before RC between October 2006 and November 2015. A propensity-score matching (1:3) was performed based on key characters. The Kaplan-Meier method was utilized to estimate survival probabilities, and the log-rank test was used to compare survival outcomes between different groups. A multivariable Cox proportional hazard model was used to estimate survival outcomes.ResultsTwenty-six patients were treated using IAC before RC, and 123 NIAC patients also underwent RC. After matching, there was no significant difference between groups in baseline characteristics, perioperative variables, complication outcomes or tumor characteristics. Compared with clinical tumor stages, pathological tumor stages demonstrated a significant decrease (P = 0.002) in the IAC group. There was no significant difference in overall survival (OS, p = 0.354) or cancer-specific survival (CSS, p = 0.439) between the groups. Among all patients, BMI significantly affected OS (p = 0.004), and positive lymph nodes (PLN) significantly affected both OS (p<0.001) and CSS (p = 0.010).ConclusionsOne-shot neoadjuvant IAC before RC shows safety and tolerability and provides a significant advantage in pathological downstaging but not in OS or CSS. Further study of neoadjuvant combination therapeutic strategies with RC is needed.

Highlights

Bladder cancer is a complex disease associated with high morbidity and mortality
To evaluate the long efficacy of one-shot neoadjuvant intra-arterial chemotherapy (IAC) versus no IAC (NIAC) before radical cystectomy (RC) for bladder cancer, we retrospectively reviewed all patients treated with RC/ pelvic lymph node dissection (PLND) between October 2006 and November 2015 for urothelial carcinoma of the bladder without distant metastasis in the Department of Urology, Beijing ChaoYang Hospital
All patients had pathologic documentation of urothelial carcinoma, which was defined as local disease or non-muscle-invasive bladder cancer (NMIBC), but the patients were at high risk for tumors [T1G3 with concurrent carcinoma in situ (CIS) at diagnosis, multiple and/or large T1G3, recurrent T1G3]

Summary

Introduction

Bladder cancer is a complex disease associated with high morbidity and mortality. Management of bladder cancer before radical cystectomy continues to be controversial. We compared the long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy (IAC) versus no IAC (NIAC) before radical cystectomy (RC) for bladder cancer. Bladder cancer is a complex disease associated with high morbidity and mortality rates. 75% of newly diagnosed patients present with non-muscleinvasive bladder cancer (MIBC), which is characterized by a high recurrence rate and 5-yr survival of ~ 90% [1]. Despite radical cystectomy (RC) with bilateral pelvic lymph node dissection (PLND) as the gold standard treatment, RC only permits a 5-yr survival in approximately 50% of patients [3, 5,6,7,8]. There was no significant improvement in bladder cancer outcomes over the last three decades

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