TY - JOUR
T1 - How to improve patient selection for neoadjuvant chemotherapy in bladder cancer patients candidate for radical cystectomy and pelvic lymph node dissection
AU - Zamboni, Stefania
AU - Moschini, Marco
AU - Antonelli, Alessandro
AU - Simeone, Claudio
AU - Belotti, Sandra
AU - Cristinelli, Luca
AU - Montorsi, Francesco
AU - Briganti, Alberto
AU - Gallina, Andrea
AU - Salonia, Andrea
AU - Colombo, Renzo
AU - Mordasini, Livio
AU - Mattei, Agostino
AU - Baumeister, Philipp
N1 - Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Purpose: To improve patient selection for neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) in bladder cancer patients (BCa). Methods: Retrospective evaluation of 1057 patients with cT2–4N0M0 BCa treatedwith RC and pelvic lymph node dissection between 1990 and 2018 at 3 referral centers. Adverse pathologic features (APF) were defined as pT3–pT4/pN + disease at RC. A regression tree model (CART) was used to assess preoperative risk group classes. A multivariable logistic regression (MVA) was performed to identify predictors of APF at RC. Results: Median age was 70 years and most of the patients were men (83%). Of the 1057 patients included in our study, 688 (65%) had APF. CART analysis was able to stratify patients into 3 risk groups: low (cT2 and single disease, odds ratio [OR] 0.62), intermediate (cT2 and multiple disease, OR 1.08), and high (cT3–cT4, OR 1.28). On MVA APF were associated with variant histology (odds ratio [OR] 3.97, 95% confidence interval [CI] 1.46–10.83, p = 0.007), multifocality at TUR (OR 2.56, CI 1.27–5.17, p = 0.09), completeness of resection (OR 0.47, CI 0.23–0.96, p = 0.04) and clinical extravesical disease (OR 3.42, CI 1.63–7.14, p = 0.001). Conclusion: We defined three pre-operative risk classes. Our results indicate that patients with a cT3–T4 disease are those who might benefit more from NAC whereas thosewith T2 single disease should be those to whom NAC probably shouldn’t be proposed. Given the high rate of understaging in BCa patients, NAC can be proposed in selected cases of cT2/multifocal disease.
AB - Purpose: To improve patient selection for neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) in bladder cancer patients (BCa). Methods: Retrospective evaluation of 1057 patients with cT2–4N0M0 BCa treatedwith RC and pelvic lymph node dissection between 1990 and 2018 at 3 referral centers. Adverse pathologic features (APF) were defined as pT3–pT4/pN + disease at RC. A regression tree model (CART) was used to assess preoperative risk group classes. A multivariable logistic regression (MVA) was performed to identify predictors of APF at RC. Results: Median age was 70 years and most of the patients were men (83%). Of the 1057 patients included in our study, 688 (65%) had APF. CART analysis was able to stratify patients into 3 risk groups: low (cT2 and single disease, odds ratio [OR] 0.62), intermediate (cT2 and multiple disease, OR 1.08), and high (cT3–cT4, OR 1.28). On MVA APF were associated with variant histology (odds ratio [OR] 3.97, 95% confidence interval [CI] 1.46–10.83, p = 0.007), multifocality at TUR (OR 2.56, CI 1.27–5.17, p = 0.09), completeness of resection (OR 0.47, CI 0.23–0.96, p = 0.04) and clinical extravesical disease (OR 3.42, CI 1.63–7.14, p = 0.001). Conclusion: We defined three pre-operative risk classes. Our results indicate that patients with a cT3–T4 disease are those who might benefit more from NAC whereas thosewith T2 single disease should be those to whom NAC probably shouldn’t be proposed. Given the high rate of understaging in BCa patients, NAC can be proposed in selected cases of cT2/multifocal disease.
KW - Bladder cancer
KW - Neoadjuvant chemotherapy
KW - Radical cystectomy
UR - http://www.scopus.com/inward/record.url?scp=85071876757&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071876757&partnerID=8YFLogxK
U2 - 10.1007/s00345-019-02916-2
DO - 10.1007/s00345-019-02916-2
M3 - Article
C2 - 31463561
AN - SCOPUS:85071876757
VL - 38
SP - 1229
EP - 1233
JO - World Journal of Urology
JF - World Journal of Urology
SN - 0724-4983
IS - 5
ER -