NEOADJUVANT CHEMOTHERAPY IN MUSCLE-INVASIVE UROTHELIAL BLADDER CANCER: CORRELATION OF RESPONSE WITH PATIENTS SURVIVAL
Authors:
Michal Staník 1; Alexander Poprach 2; Daniel Macík 1; Ivo Čapák 1; Jiří Jarkovský 3; Denisa Malúšková 3; Natália Marečková 1; Radek Lakomý 2; Jan Doležel 1
Authors place of work:
Oddělení onkourologie, Masarykův onkologický ústav, Brno
1; Klinika komplexní onkologické péče, Masarykův onkologický ústav, Brno
2; Institut biostatistiky a analýz, Masarykova univerzita, Brno
3
Published in the journal:
Ces Urol 2016; 20(3): 221-228
Category:
Original Articles
Summary
Major statement:
Response rates to neoadjuvant chemotherapy were high in our cohort of 41 patients with muscle-invasive bladder cancer. Patients with a complete response had significantly improved 2-year progression-free survival compared with the patients with residual disease.
Aims:
Neoadjuvant chemotherapy (NAC) was shown to improve the overall survival in randomized trials. The aim of the study was to evaluate the frequency of response to NAC and the impact on prognosis of the disease.
Methods:
From January 2010 to October 2015 124 patients with bladder cancer underwent radical cystectomy and 41 of them (33 %) received NAC. Chemotherapy was indicated in cT3–4 or cN+ tumours, cT2N0 disease only in presence of risk factors like hydronephrosis or lymphovascular invasion.
Glomerular filtration rate >50 ml/min and ECOG performance status ≤1 were used as chemotherapy eligibility criteria. Gemcitabine and cisplatin was the most frequently used regimen (85 %). Response to chemotherapy was defined as complete (ypT0N0) or partial (≤ypT1N0). The median follow-up was 14 months (1–71). The Kaplan-Meier methods were used to calculate two-year progression-free survival (PFS) and subgroup survival comparison using log-rank test.
Results:
Two-year PFS rates were 69 % (95 % CI 52–86) for the whole cohort and 81 % in patients with clinically negative lymph nodes (cT2–4N0). Complete or partial responses to NAC were seen in 41 % and 59 %, respectively. The probability of attaining at least partial response to NAC (≤ ypT1N0) was significantly higher in cT2 tumours (76 %) than in cT3–4 (40 %). Two-year PFS was significantly higher in case of response to chemotherapy: 93 % in ypT0, 83 % in ypT1, 50 % in ypT2 and 31 % in ypT3–4 (p=0.003).
Conclusion:
Patients with a response to NAC had significantly improved 2-year PFS compared with the patients without the response. In the future, the development of new molecular biomarkers is warranted, that would allow better selection of patients to NAC.
KEY WORDS:
Chemotherapy, neoadjuvant therapy, urinary bladder neoplasms.
Zdroje
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Štítky
Paediatric urologist Nephrology UrologyČlánok vyšiel v časopise
Czech Urology
2016 Číslo 3
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