Final Pathological Stage after Neoadjuvant Chemotherapy and Radical Cystectomy for Bladder Cancer—Does pT0 Predict Better Survival than pTa/Tis/T1?

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• 作者：Homayoun Zargar^a ; ^&lowast ; ; Kamran Zargar-Shoshtari^b ; ^&lowast ; ; Yair Lotan^c ; ^&lowast ; ; Jay B. Shah^d ; ^&lowast ; ; Bas W. van Rhijn^e ; ^&dagger ; ; Siamak Daneshmand^f ; ^&lowast ; ; Philippe E. Spiess^b ; ^&lowast ; ; Peter Black^a ; ^&lowast ; ; ^{pblack@mail.ubc.ca" class="auth_mail" title="E-mail the corresponding author} ; CollaboratorsAdrian S. Fairey ; Laura S. Mertens ; Simon Horenblas ; Colin P. Dinney ; Maria C. Mir ; Cesar E. Ercole ; Andrew J. Stephenson ; Laura-Maria Krabbe ; Michael S. Cookson ; Niels-Erik Jacobsen ; Daniel A. Barocas ; Joshua Griffin ; Jeff M. Holzbeierlein ; Jeffrey S. Montgomery ; Todd M. Morgan ; Nikhil Vasdev ; Andrew C. Thorpe ; Jonathan Aning ; Evan Y. Yu ; Jonathan L. Wright ; Evanguelos Xylinas ; Nicholas J. Campain ; Farshad Pourmalek ; John S. McGrath ; Wassim Kassouf ; Marc A. Dall'Era ; Jo-An Seah ; Srikala S. Sridhar ; Pranav Sharma ; Shahrokh F. Shariat ; Scott North ; Petros Grivas ; Nilay Gandhi ; Trinity J. Bivalacqua
• 关键词：neoadjuvant therapy ; drug therapy ; cystectomy ; urinary bladder neoplasms
• 刊名：The Journal of Urology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：195
• 期：4
• 页码：886-893
• 全文大小：589 K

文摘

We assessed survival dependent on pathological response after neoadjuvant chemotherapy in a large multicenter patient cohort, with a particular focus on the difference between the absence of residual cancer (pT0) and the presence of only nonmuscle invasive residual cancer (pTa, pTis, pT1).

d="absSec_2">Materials and Methods

d="abspara0015">We retrospectively reviewed records of patients with urothelial cancer who received neoadjuvant chemotherapy and underwent radical cystectomy at 19 contributing institutions from 2000 to 2013. Patients with cT2-4aN0M0 and eventual pN0 disease were selected for this analysis. Estimated overall survival was compared between patients with pT0 and pTa/Tis/T1 disease. A multivariable Cox proportional hazards regression model for overall survival was generated to evaluate hazard ratios for variables of interest.

d="absSec_3">Results

d="abspara0020">Of 1,543 patients treated with neoadjuvant chemotherapy and radical cystectomy during the study period 257 had pT0N0 and 207 had pTa/Tis/T1N0 disease. The Kaplan-Meier mean estimates of overall survival for pT0 and pTa/Tis/T1 cases were 186.7 months (95% CI 145.9–227.6, median 241.1) and 138 months (95% CI 118.2–157.8, median 187.4), respectively (p=0.58). In the Cox proportional hazards regression model for overall survival pTa/Tis/T1N0 status (HR 0.36, 95% CI 0.23–0.67) and pT0N0 status (HR 0.28, 95% CI 0.17–0.47) compared to pT2N0 pathology, positive surgical margin (HR 1.75, 95% CI 1.07–2.86), and receiving a methotrexate, vinblastine, doxorubicin and cisplatin regimen compared to an “other” regimen (HR 0.45, 95% CI 0.27–0.76) were predictors of overall survival.

d="absSec_4">Conclusions

d="abspara0025">pTa/Tis/T1N0 and pT0N0 stage on the final cystectomy specimen are strong predictors of survival in patients treated with neoadjuvant chemotherapy and radical cystectomy. We did not discern a statistically significant difference in overall survival when comparing these 2 end points.