Concomitant CIS on TURBT does not impact oncological outcomes in patients treated with neoadjuvant or induction chemotherapy followed by radical cystectomy.

Autor: Vasdev N; Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, SG1 4AB, UK. nikhil.vasdev@nhs.net.; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK. nikhil.vasdev@nhs.net.; Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK. nikhil.vasdev@nhs.net., Zargar H; Department of Urology, Royal Melbourne Hospital, Melbourne, VIC, Australia.; Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.; Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada., Noël JP; Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, SG1 4AB, UK.; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK., Veeratterapillay R; Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK., Fairey AS; USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA.; University of Alberta, Edmonton, AB, Canada., Mertens LS; Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Dinney CP; Department of Urology, MD Anderson Cancer Center, Houston, TX, USA., Mir MC; Department of Urology, Royal Melbourne Hospital, Melbourne, VIC, Australia.; Department of Surgery, University of Melbourne, Melbourne, VIC, Australia., Krabbe LM; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Cookson MS; Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA., Jacobsen NE; University of Alberta, Edmonton, AB, Canada., Gandhi NM; Department of Urology, The Johns Hopkins School of Medicine, The James Buchanan Brady Urological Institute, Baltimore, MD, USA., Griffin J; Department of Urology, Medical Center, University of Kansas, Kansas City, KS, USA., Montgomery JS; Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA., Yu EY; Division of Oncology, Department of Medicine, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA, USA., Xylinas E; Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, NY, USA., Campain NJ; Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK., Kassouf W; (Division of Urology) Department of Surgery, McGill University Health Center, Montreal, QC, Canada., Dall'Era MA; Department of Urology, Davis Medical Center, University of California at Davis, Sacramento, CA, USA., Seah JA; Princess Margaret Cancer Center, Toronto, ON, Canada., Ercole CE; Department of Urology, Royal Melbourne Hospital, Melbourne, VIC, Australia.; Department of Surgery, University of Melbourne, Melbourne, VIC, Australia., Horenblas S; Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Sridhar SS; Princess Margaret Cancer Center, Toronto, ON, Canada., McGrath JS; Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK., Aning J; Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK.; Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK., Shariat SF; Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, NY, USA.; Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria., Wright JL; Division of Oncology, Department of Medicine, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA, USA., Morgan TM; Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA., Bivalacqua TJ; Department of Urology, The Johns Hopkins School of Medicine, The James Buchanan Brady Urological Institute, Baltimore, MD, USA., North S; Cross Cancer Institute, Edmonton, AB, Canada., Barocas DA; Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Lotan Y; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Grivas P; Division of Oncology, Department of Medicine, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA, USA., Stephenson AJ; Department of Urology, Royal Melbourne Hospital, Melbourne, VIC, Australia.; Department of Surgery, University of Melbourne, Melbourne, VIC, Australia., Shah JB; Department of Urology, MD Anderson Cancer Center, Houston, TX, USA., van Rhijn BW; Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Daneshmand S; USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA., Spiess PE; Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA., Holzbeierlein JM; Department of Urology, Medical Center, University of Kansas, Kansas City, KS, USA., Thorpe A; Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK., Black PC; Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2019 Jan; Vol. 37 (1), pp. 165-172. Date of Electronic Publication: 2018 Jun 07.
DOI: 10.1007/s00345-018-2361-0
Abstrakt: Background: Cisplatin-based neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer improves all-cause and cancer specific survival. We aimed to evaluate whether the detection of carcinoma in situ (CIS) at the time of initial transurethral resection of bladder tumor (TURBT) has an oncological impact on the response to NAC prior to radical cystectomy.
Patients and Methods: Patients were identified retrospectively from 19 centers who received at least three cycles of NAC or induction chemotherapy for cT2-T4aN0-3M0 urothelial carcinoma of the bladder followed by radical cystectomy between 2000 and 2013. The primary and secondary outcomes were pathological response and overall survival, respectively. Multivariable analysis was performed to determine the independent predictive value of CIS on these outcomes.
Results: Of 1213 patients included in the analysis, 21.8% had concomitant CIS. Baseline clinical and pathologic characteristics of the 'CIS' versus 'no-CIS' groups were similar. The pathological response did not differ between the two arms when response was defined as pT0N0 (17.9% with CIS vs 21.9% without CIS; p = 0.16) which may indicate that patients with CIS may be less sensitive to NAC or ≤ pT1N0 (42.8% with CIS vs 37.8% without CIS; p = 0.15). On Cox regression model for overall survival for the cN0 cohort, the presence of CIS was not associated with survival (HR 0.86 (95% CI 0.63-1.18; p = 0.35). The presence of LVI (HR 1.41, 95% CI 1.01-1.96; p = 0.04), hydronephrosis (HR 1.63, 95% CI 1.23-2.16; p = 0.001) and use of chemotherapy other than ddMVAC (HR 0.57, 95% CI 0.34-0.94; p = 0.03) were associated with shorter overall survival. For the whole cohort, the presence of CIS was also not associated with survival (HR 1.05 (95% CI 0.82-1.35; p = 0.70).
Conclusion: In this multicenter, real-world cohort, CIS status at TURBT did not affect pathologic response to neoadjuvant or induction chemotherapy. This study is limited by its retrospective nature as well as variability in chemotherapy regimens and surveillance regimens.
Databáze: MEDLINE
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