Purpose: To investigate the prevalence of and factors’ association with receiving suboptimal neoadjuvant chemotherapy (NAC) and its impact on survival outcomes in patients with muscle-invasive bladder cancer (MIBC) treated with radical cystectomy (RC). Methods: We reviewed 1119 patients treated with NAC and/or RC for cT2-cT4N0M0 BC. Patients were segregated into three groups: (i) suboptimal NAC (received < 3 cycles of cisplatin-based NAC or non-cisplatin-based regimen), (ii) optimal NAC and (iii) no NAC. Clinical characteristics were compared among groups. Logistic regression analyses tested the association between clinical variables and the odds of receiving suboptimal NAC. To adjust for potential baseline confounders, propensity score matching was performed. Pathologic outcomes were compared between groups and Cox regression analyses tested the risk factors associated with recurrence, overall (OM) and cancer-specific mortality (CSM). Results: Before matching, 84/315 (26.6%) patients received a suboptimal NAC regimen. Lower general health status and impaired renal functions were the most significant factors associated with the administration of a suboptimal NAC. After matching, the optimal NAC group achieved higher rates of complete pathological response as compared to the suboptimal group (p = 0.03). Suboptimal NAC (HR 1.77; p = 0.015) and no NAC (HR 1.52; p = 0.03) were both associated with higher risk of recurrence and OM (HR 1.71; p = 0.02 and HR 1.61; p = 0.02) as compared to optimal NAC. Conclusion: One out of four MIBC patients received a suboptimal NAC regimen before RC. Receiving a suboptimal NAC regimen was associated with worse disease recurrence and survival outcomes following surgery, as compared to an optimal NAC regimen.
Clinical predictors and survival outcome of patients receiving suboptimal neoadjuvant chemotherapy and radical cystectomy for muscle-invasive bladder cancer : a single-center experience / L. Boeri, M. Soligo, I. Frank, S.A. Boorjian, R.H. Thompson, M. Tollefson, R. Tarrel, F.J. Quevedo, J.C. Cheville, R.J. Karnes. - In: WORLD JOURNAL OF UROLOGY. - ISSN 0724-4983. - 37:11(2019 Nov), pp. 2409-2418.
|Titolo:||Clinical predictors and survival outcome of patients receiving suboptimal neoadjuvant chemotherapy and radical cystectomy for muscle-invasive bladder cancer : a single-center experience|
BOERI, LUCA (Corresponding)
|Parole Chiave:||Bladder cancer; Cisplatin; Neoadjuvant chemotherapy; Risk factors; Survival outcomes; Adult; Aged; Aged, 80 and over; Chemotherapy, Adjuvant; Female; Humans; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Invasiveness; Prognosis; Retrospective Studies; Survival Rate; Urinary Bladder Neoplasms; Cystectomy|
|Settore Scientifico Disciplinare:||Settore MED/24 - Urologia|
|Data di pubblicazione:||nov-2019|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1007/s00345-019-02689-8|
|Appare nelle tipologie:||01 - Articolo su periodico|
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