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. 2022 Dec;54(12):3145-3152.
doi: 10.1007/s11255-022-03339-6. Epub 2022 Aug 23.

Survival outcomes of patients with muscle-invasive bladder cancer according to pathological response at radical cystectomy with or without neo-adjuvant chemotherapy: a case-control matching study

Noor van Ginkel  1 , Tom J N Hermans  2 , Dennie Meijer  1 , Joost L Boormans  3 , Jens Voortman  4 , Laura Mertens  5 , Sytse C van Beek #  3 , André N Vis #  6 ; Dutch Cystectomy Snapshot Research Group
Collaborators, Affiliations

Survival outcomes of patients with muscle-invasive bladder cancer according to pathological response at radical cystectomy with or without neo-adjuvant chemotherapy: a case-control matching study

Noor van Ginkel et al. Int Urol Nephrol. 2022 Dec.

Abstract

Objectives: To assess survival of patients with muscle-invasive bladder cancer (MIBC) who underwent radical cystectomy (RC) with or without neo-adjuvant chemotherapy (NAC) according to the pathological response at RC.

Methods: 965 patients with MIBC (cT2-4aN0M0) who underwent RC with or without NAC were analyzed. Among the collected data were comorbidity, clinical and pathological tumor stage, tumor grade, nodal status (y)pN, and OS. Case-control matching of 412 patients was performed to compare oncological outcomes. Kaplan-Meier curves were created to estimate OS for patients who underwent RC with or without NAC, and for those with complete response (pCR), partial response (pPR), or residual or progressive disease (PD).

Results: Patients with a pCR or pPR at RC, with or without NAC, had better OS than patients who had PD (both p values < 0.001). Moreover, the incidence of pCR was significantly higher in patients receiving NAC prior to RC than in patients undergoing RC only (31% versus 15%, respectively; p < 0.001). Case-control matching displayed better OS of patients who underwent RC with NAC, median survival not reached, than of those who underwent RC only, median 4.5 years (p = 0.023).

Conclusions: This study showed that patients with MIBC who underwent NAC with RC had a significant better OS than those who underwent RC only. The proportion of patients with a pCR was higher in those who received NAC and RC than in those who were treated by RC only. The favorable OS rate in the NAC and RC cohort was probably attributed to the higher observed pCR rate.

Keywords: Chemotherapy; Muscle-invasive bladder cancer; Prognosis; Response.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Kaplan Meier curves. a Overall survival in 965 patients with muscle-invasive bladder cancer who were treated by radical cystectomy (RC) with or without neo-adjuvant chemotherapy (NAC), stratified by pathological response at RC. b Overall survival after case–control matching of patients with muscle-invasive bladder cancer treated with NAC followed by RC (n = 206, curve in red) versus patients treated by RC only (n = 206, curve in blue). c Overall survival after case–control matching of patients with residual muscle-invasive disease at radical cystectomy (RC) for patients treated by RC only (n = 156, curve in blue) and those treated with NAC followed by RC (n = 117, curve in red)
See this image and copyright information in PMC

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