The Promise and Disappointment of Neoadjuvant Chemotherapy and Transurethral Resection for Muscle Invasive Bladder Cancer: Updated Results and Long-Term Followup.
Autor: | Yap SA; Department of Urology, University of California, Davis, Sacramento, California.; University of California Davis Comprehensive Cancer Center, Sacramento, California.; Division of Urology, Department of Surgery, VA Northern California Health Care System, Sacramento, California., Pugashetti N; Department of Urology, University of California, Davis, Sacramento, California., Chandrasekar T; Department of Urology, University of California, Davis, Sacramento, California., Dall'Era MA; Department of Urology, University of California, Davis, Sacramento, California.; University of California Davis Comprehensive Cancer Center, Sacramento, California., Evans CP; Department of Urology, University of California, Davis, Sacramento, California.; University of California Davis Comprehensive Cancer Center, Sacramento, California., Lara PN; Department of Urology, University of California, Davis, Sacramento, California.; Division of Hematology/Oncology, Department of Internal Medicine, University of California, Davis, Sacramento, California.; University of California Davis Comprehensive Cancer Center, Sacramento, California., deVere White RW; Department of Urology, University of California, Davis, Sacramento, California.; University of California Davis Comprehensive Cancer Center, Sacramento, California. |
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Jazyk: | angličtina |
Zdroj: | Urology practice [Urol Pract] 2018 Jul; Vol. 5 (4), pp. 305-310. Date of Electronic Publication: 2017 Jul 21. |
DOI: | 10.1016/j.urpr.2017.07.001 |
Abstrakt: | Introduction: Radical cystectomy with neoadjuvant chemotherapy is the standard of care for patients with localized muscle invasive urothelial carcinoma of the bladder. One of the strongest predictors of survival in these patients is pathological response to initial treatment. Our objective was to determine whether we could stratify the need for radical cystectomy based on pathological response to neoadjuvant chemotherapy. Methods: We present a cohort of patients with muscle invasive urothelial carcinoma of the bladder to whom surveillance and bladder preservation were offered if complete response was achieved following neoadjuvant chemotherapy. Descriptive statistics and survival analysis were performed to assess overall, cancer specific and metastasis-free survival. Patients were stratified based on pathological response to neoadjuvant chemotherapy. Results: A total of 60 patients were included in the cohort, of whom 32 (55%) had absence of residual disease on post-neoadjuvant chemotherapy transurethral resection and 27 (45%) had persistent disease. Of patients undergoing surveillance 52% maintained the bladder without evidence of recurrence. By comparison, of those with recurrence only 20% preserved the bladder and were without evidence of disease. Conclusions: Long-term followup shows a subset of patients achieving good outcomes while preserving the bladder. However, we also observed an inability to reliably identify this subset of patients given current clinical and pathological markers. Until we are able to achieve that goal, the safest oncologic approach remains neoadjuvant chemotherapy followed by radical cystectomy. |
Databáze: | MEDLINE |
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