Use of treatment pathway improves neoadjuvant chemotherapy use in muscle-invasive bladder cancer

Faraj, Kassem; Navaratnam, Anojan; Eversman, Sarah; Elias, Laila; Syal, Amit; Tyson, Mark D.; Castle, Erik P.

doi:10.1007/s11255-020-02752-z

Cited by 1 publication

(2 citation statements)

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“…Current guidelines recommend to offer neoadjuvant cisplatin-containing chemotherapy to all patients with muscle-invasive bladder cancer. Nevertheless, neoadjuvant chemotherapy is still not widely accepted due to the risk of potential overtreatment in a subgroup of patients [ 4 , 5 ]. Selection of patients for neoadjuvant treatment is challenging.…”

Section: Discussionmentioning

confidence: 99%

“…Neoadjuvant cisplatin-containing chemotherapy (NAC) is associated with an overall survival benefit of 5–8% [ 1 , 2 ] in muscle-invasive urothelial bladder cancer (UBC) and according to international guidelines should be offered to all cisplatin-eligible patients prior to radical cystectomy [ 3 ]. Nevertheless, NAC is still not widely accepted for different reasons [ 4 , 5 ]. One debate is the potential overtreatment of patients with pT2pN0 disease, as cystectomy series show a favorable prognosis for patients with pT2 tumors in comparison with patients with locally advanced pT3/T4 tumors [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Both radiographical and pathological lymph node statuses are independent predictors for survival following neoadjuvant chemotherapy and radical cystectomy for cT3/4 or cN+ bladder cancer

et al. 2022

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Introduction Urothelial bladder cancer (UBC) with clinical suspicion of locally advanced growth or pelvic lymphogenic spread has a high risk of progression and death. Patients and methods Bladder cancer patients with locally advanced (cT3/4) tumor growth or suspected pelvic lymphogenic spread (cN+) were treated with preoperative cisplatin-containing chemotherapy and consolidative cystectomy with pelvic lymphadenectomy. We aimed to identify prognostic factors and describe the patients’ oncological outcome. Results A complete dataset including follow-up data was available for 96 patients. In a univariate analysis, we identified cN stage (cN+ vs cN-, HR 2.7, 95% CI 1.3–6.0), response to chemotherapy (HR 0.2, 95% CI 0.1–0.5), ypT stage (ypT0/is/1 vs ypT2-4, HR 3.1, 95% CI 1.4–6.8), ypN stage (ypN + vs ypN-, HR 7.9, 95% CI 3.7–17.0), resection status (HR 4.4, 95% CI HR 1.5–13.0) as significantly associated with cancer-specific survival. In a multivariate regression analysis, both cN and ypN statuses were validated as independent prognostic factors for cancer-specific survival (cN: HR 2.6, 95% CI 1.1–6.1; ypN: HR 5.5, 95% CI 2.0–15.1). Discussion Lymph node status was identified as a prognostic marker in a high-risk cohort of UBC patients treated with inductive chemotherapy and cystectomy. Establishing cN status as a prognosticator underlines the necessity to aggressively treat these patients despite reported impreciseness of imaging procedures in UCB. Patients with histologically positive lymph nodes following preoperative chemotherapy have a very poor prognosis, and thus, the need for adjuvant systemic treatment is emphasized. Conclusion Both clinically and pathologically affected lymph nodes convey a poor prognosis in bladder cancer and necessitate aggressive treatment.

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Section: Discussionmentioning

confidence: 99%