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

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..

Medienart:

E-Artikel

Erscheinungsjahr:

2018

Erschienen:

2018

Enthalten in:

Zur Gesamtaufnahme - volume:37

Enthalten in:

World journal of urology - 37(2018), 1 vom: 07. Juni, Seite 165-172

Sprache:

Englisch

Beteiligte Personen:

Vasdev, N. [VerfasserIn]
Zargar, H. [VerfasserIn]
Noël, J. P. [VerfasserIn]
Veeratterapillay, R. [VerfasserIn]
Fairey, A. S. [VerfasserIn]
Mertens, L. S. [VerfasserIn]
Dinney, C. P. [VerfasserIn]
Mir, M. C. [VerfasserIn]
Krabbe, L. M. [VerfasserIn]
Cookson, M. S. [VerfasserIn]
Jacobsen, N. E. [VerfasserIn]
Gandhi, N. M. [VerfasserIn]
Griffin, J. [VerfasserIn]
Montgomery, J. S. [VerfasserIn]
Yu, E. Y. [VerfasserIn]
Xylinas, E. [VerfasserIn]
Campain, N. J. [VerfasserIn]
Kassouf, W. [VerfasserIn]
Dall’Era, M. A. [VerfasserIn]
Seah, J. A. [VerfasserIn]
Ercole, C. E. [VerfasserIn]
Horenblas, S. [VerfasserIn]
Sridhar, S. S. [VerfasserIn]
McGrath, J. S. [VerfasserIn]
Aning, J. [VerfasserIn]
Shariat, S. F. [VerfasserIn]
Wright, J. L. [VerfasserIn]
Morgan, T. M. [VerfasserIn]
Bivalacqua, T. J. [VerfasserIn]
North, S. [VerfasserIn]
Barocas, D. A. [VerfasserIn]
Lotan, Y. [VerfasserIn]
Grivas, P. [VerfasserIn]
Stephenson, A. J. [VerfasserIn]
Shah, J. B. [VerfasserIn]
van Rhijn, B. W. [VerfasserIn]
Daneshmand, S. [VerfasserIn]
Spiess, P. E. [VerfasserIn]
Holzbeierlein, J. M. [VerfasserIn]
Thorpe, A. [VerfasserIn]
Black, P. C. [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

Themen:

Bladder cancer
Carcinoma insitu
Neoadjuvant chemotherapy
Radical cystectomy

RVK:

RVK Klassifikation

Anmerkungen:

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

doi:

10.1007/s00345-018-2361-0

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2092640208

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