Correlation of Pathologic Complete Response with Survival After Neoadjuvant Chemotherapy in Bladder Cancer Treated with Cystectomy: A Meta-analysis

Petrelli, Fausto; Coinu, Andrea; Cabiddu, Mary; Ghilardi, Mara; Vavassori, Ivano; Barni, Sandro

doi:10.1016/j.eururo.2013.06.049

Cited by 264 publications

(168 citation statements)

References 36 publications

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“…The instillation of chemodrug or Bacillus Calmette-Guérin (BCG) plus transurethral resection of BCa (TUR-bt) procedure is considered to be the most effective treatment for T1 and T2a superficial BCa (5). For Ta, Tis superficial BCa and invasive BCa, surgery (including radical cystectomy) accompanied by cisplatin-based chemotherapy is recommended and proved to be effective for promoting the progress-free survival (PFS) of patients (6)(7)(8)(9). However, in instillation of chemodrug for superficial BCa or systematic chemotherapy for invasive BCa, chemoresistance is the vital obstacle, leading to treatment failure, whereas, the mechanism of how chemoresistance develops is still unclear (7).…”

Section: Introductionmentioning

confidence: 99%

HIF-1α/MDR1 pathway confers chemoresistance to cisplatin in bladder cancer

et al. 2015

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Abstract. Bladder cancer (BCa) is the 9th most common malignant tumor and the 13th leading cause of death due to cancer. The development of surgery and target drugs bring new challenges for the traditional concept for BCa therapy, and chemotherapy is still the final option for many BCa patients, and cisplatin-containing regimen the most effective one. However, the ubiquitous application of cisplatin-containing regimen in BCa results in the cisplatin-resistance, in addition, the cisplatin-resistant BCa manifests enhanced malignant behavior, the mechanism of which is unclear. In the present study, we used BCa cell lines to to clarify this point. BCa cell lines T24/J82 were pretreated with cisplatin >3 months to construct stable cisplatin-resistant cell lines (tagged T24Cis-R and J82Cis-R ), which manifested as enhanced capacity of proliferation and malignant behavior in vivo and in vitro, accompanied by cisplatin, and even doxorubicin resistance. The following mechanism dissection revealed that prolonged treatment time of T24/J82 cells led to elevated expression of HIF-1α, which targeted the increased expression of MDR1 on the one hand, and contributed to BCa cell proliferation, migration/invasion on the other hand. Finally, IHC staining of human BCa tissue supported our conclusion that the expression of HIF-1α and MDR1 was higher in chemoresistant tissue vs. chemosensitive tissue. Our results provided a new view of HIF-1α in chemotherapy.

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Section: Introductionmentioning

confidence: 99%

HIF-1α/MDR1 pathway confers chemoresistance to cisplatin in bladder cancer

et al. 2015

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“…The ultimate goal of NACH is to improve the survival times of patients. As mentioned earlier, tumor downstaging following NACH closely correlated with survival (11,(13)(14)(15)(16). Although we did not directly assess the association between pCR and survival, it was expected that pCR after NACH would positively affect survival outcomes among patients with MIBC.…”

Section: Discussionmentioning

confidence: 83%

“…In particular, chemo-induced tumor downstaging is considered to be a useful and potential surrogate marker that has been associated with favorable survival outcomes among patients treated with subsequent RC (11,(13)(14)(15)(16). The impact of various NACH regimens including CM, CMV, MVAC, and GC, on the achievement of pCR and on survival outcomes has been evaluated by many investigators, both retrospectively and prospectively (14,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33).…”

Section: Discussionmentioning

confidence: 99%

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Pathological T0 Following Cisplatin-Based Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: A Network Meta-analysis

Kim

Jeong

Kwak

et al. 2016

Clinical Cancer Research

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Purpose: To systematically assess and compare the relationship between various neoadjuvant chemotherapy regimens and pCR in patients with muscle-invasive bladder cancer.Experimental design: We performed a literature search of PubMed, Embase, and the Cochrane Library for all articles published before March 2015 and according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. There were 17 articles that met the study eligibility criteria and were selected for the final analysis. A direct pair-wise meta-analysis was performed for studies that compared the same regimen. Finally, a Bayesian network meta-analysis was used to indirectly compare the regimens.Results: In a pair-wise meta-analysis, the methotrexate/vinblastine/Adriamycin/cisplatin [MVAC; OR, 4.36; 95% confidence interval (CI), 2.71-7.02] and gemcitabine/cisplatin (GC) regimens (OR, 4.92; 95% CI, 2.93-8.24) were significantly associated with a better pCR than RC alone. In a network meta-analysis, there was no significant difference in terms of pCR achievement between the GC and MVAC regimens (OR, 1.14; 95% CI; 0.85-1.70). However, in a subgroup network meta-analysis that only included prospective randomized trials, the MVAC regimen was significantly correlated with a higher rate of pCR (OR, 5.75; 95% CI,.Conclusions: The results of this meta-analysis suggest that a GC regimen was associated with a pCR rate that was similar to that of a MVAC regimen based on retrospective data, but only the MVAC regimen was proven to achieve pCR in prospective randomized trials. Additional prospective randomized trials comparing both regimens will be necessary to establish the optimal neoadjuvant chemotherapy regimen.

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“…18 Pathologic complete response (pCR) in the form of pT0N0M0 stage is clearly associated with a 55% lower risk of death and an 80% lower risk of recurrence compared with patients with any residual disease. 19 Among total number of 59 patients, pCR was observed in 15 specimens (25.4%), 20 (33.9%) showed pTa, pTis and pT1 disease, six were pT2 (10.2%), twelve were pT3 (20.3%) and six were pT4a (10.2%). Fifty specimens were node negative (84.7%) and nine were N+ (15.3%).…”

Section: Discussionmentioning

confidence: 90%

Surgery after neoadjuvant chemotherapy for muscle invasive bladder cancer: clinicopathological and surgical outcomes

Denewer¹,

Atallah²,

Wahab³

et al. 2018

Int Surg J

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Background: Neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) is the standard of care for muscle-invasive bladder cancer (MIBC) owing to the survival advantage, which has correlated with down-staging of the cancer to pT0. This approach is underused because it may be associated with increased perioperative morbidity and mortality rates. This study was designed to evaluate NAC plus RC regarding pathological response, perioperative morbidity and mortality outcomes. Methods: This is a prospective study that was carried out from August 2015 till July 2017 for patients with bladder carcinoma. We enrolled all cases with ≥ T2 bladder receiving NAC. Patients with metastatic disease, poor performance were excluded from this study.Results: pathological response rate and Complications occurred within 30 and 90 d after surgery. Heterologous blood transfusions, length of stay, readmission, and perioperative morbidity, and mortality were compared.Conclusions: Our results suggest that non-urothelial tumor showed no response to Platinum based combination chemotherapeutic regimens. NAC followed by RC gives no more perioperative complications.

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Correlation of Pathologic Complete Response with Survival After Neoadjuvant Chemotherapy in Bladder Cancer Treated with Cystectomy: A Meta-analysis

Cited by 264 publications

References 36 publications

HIF-1α/MDR1 pathway confers chemoresistance to cisplatin in bladder cancer

HIF-1α/MDR1 pathway confers chemoresistance to cisplatin in bladder cancer

Pathological T0 Following Cisplatin-Based Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: A Network Meta-analysis

Surgery after neoadjuvant chemotherapy for muscle invasive bladder cancer: clinicopathological and surgical outcomes

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