Assessing Cancer Progression and Stable Disease after Neoadjuvant Chemotherapy for Organ-Confined Muscle-Invasive Bladder Cancer

Abstract Objective To propose and validate a new approach to stratify clinically staged organ-confined muscle-invasive bladder cancer patients (cT2N0M0) that are pathologic non-responders to neoadjuvant chemotherapy (NAC) to better characterize NAC non-response. Methods We retrospectively identified...

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Published in:Urology (Ridgewood, N.J.) N.J.), 2017-04, Vol.102, p.148-158
Main Authors: Chappidi, Meera R., M.P.H, Kates, Max, M.D, Brant, Aaron, B.S, Baras, Alexander S., M.D., Ph.D, Netto, George J., M.D, Pierorazio, Phillip M., M.D, Hahn, Noah M., M.D, Bivalacqua, Trinity J., M.D., Ph.D
Format: Article
Language:English
Subjects:
Aged
Chemotherapy, Adjuvant
Disease Progression
Female
Humans
Male
Muscle, Smooth - pathology
Neoadjuvant Therapy
Neoplasm Invasiveness
Neoplasm Staging
Retrospective Studies
Survival Rate
Urinary Bladder Neoplasms - drug therapy
Urinary Bladder Neoplasms - mortality
Urinary Bladder Neoplasms - pathology
Urology
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Summary:Abstract Objective To propose and validate a new approach to stratify clinically staged organ-confined muscle-invasive bladder cancer patients (cT2N0M0) that are pathologic non-responders to neoadjuvant chemotherapy (NAC) to better characterize NAC non-response. Methods We retrospectively identified radical cystectomy patients with cT2N0M0 disease at our institution (2005-2014) and in the National Cancer Database (NCDB, 2004-2012) for external validation. Patients were stratified as stable (pT2N0M0) or progressors (>pT2 and/or pN+). Primary endpoints were cancer-specific (CSS), overall (OS), and recurrence free survival (RFS). Results In the institutional cohort, NAC stable (n=17) had better OS (p=0.05) and RFS (p=0.04) than NAC progressors (n=50) and comparable OS (p=0.7) and CSS (p=0.09) compared to non-NAC stable (n=27). Multivariable cox proportional hazards models showed larger tumor size (per cm) predicted worse OS (HR=1.20, 95%CI[1.07-1.35]), CSS (HR=1.27, 95%CI[1.11-1.45]), and RFS (HR=1.24, 95%CI[1.09-1.42]). Similarly, in the NCDB, NAC stable (n=223) had improved OS (p
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2016.10.064