Impact of Adjuvant Chemotherapy on Survival of Patients with Advanced Residual Disease at Radical Cystectomy following Neoadjuvant Chemotherapy

Background: Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) with pelvic lymph-node dissection is the standard treatment for cT2-4a cN0 cM0 muscle-invasive bladder cancer (MIBC). Despite the significant improvement of primary-tumor downstaging with NAC, up to 50% of...

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Detalles Bibliográficos
Autores: Krajewski, Wojciech, Nowak, Łukasz|||0000-0003-4273-8196, Moschini, Marco|||0000-0002-3084-2458, Poletajew, Sławomir|||0000-0001-7664-9816, Chorbińska, Joanna, Necchi, Andrea, Montorsi, Francesco, Briganti, Alberto|||0000-0002-2178-0494, Sanchez-Salas, Rafael, Shariat, Shahrokh|||0000-0002-6627-6179, Palou, Juan|||0000-0003-1264-5327, Babjuk, Marek|||0000-0002-3115-7428, Teoh, Jeremy Y. C., Soria, Francesco|||0000-0001-8443-8453, Pradere, Benjamin|||0000-0002-7768-8558, Ornaghi, Paola Irene|||0000-0003-2863-6871, Pawlak, Aleksandra|||0000-0002-7449-1661, Dembowski, Janusz, Zdrojowy, Romuald
Tipo de recurso: artículo
Fecha de publicación:2021
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:252371
Acceso en línea:https://ddd.uab.cat/record/252371
https://dx.doi.org/urn:doi:10.3390/jcm10040651
Access Level:acceso abierto
Palabra clave:Adjuvant chemotherapy
Muscle-invasive bladder cancer
Neoadjuvant chemotherapy
Descripción
Sumario:Background: Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) with pelvic lymph-node dissection is the standard treatment for cT2-4a cN0 cM0 muscle-invasive bladder cancer (MIBC). Despite the significant improvement of primary-tumor downstaging with NAC, up to 50% of patients are eventually found to have advanced residual disease (pT3-T4 and/or histopathologically confirmed nodal metastases (pN+)) at RC. Currently, there is no established standard of care in such cases. The aim of this systematic review and meta-analysis was to assess differences in survival rates between patients with pT3-T4 and/or pN+ MIBC who received NAC and surgery followed by adjuvant chemotherapy (AC), and patients without AC. Materials and Methods: A systematic search was conducted in accordance with the PRISMA statement using the Medline, Embase, and Cochrane Library databases. The last search was performed on 12 November 2020. The primary end point was overall survival (OS) and the secondary end point was disease-specific survival (DSS). Results: We identified 2124 articles, of which 6 were selected for qualitative and quantitative analyses. Of a total of 3096 participants in the included articles, 2355 (76.1%) were in the surveillance group and 741 (23.9%) received AC. The use of AC was associated with significantly better OS (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.75-0.94; p = 0.002) and DSS (HR 0.56, 95% CI 0.32-0.99; p = 0.05). Contrary to the main analysis, in the subgroup analysis including only patients with pN+, AC was not significantly associated with better OS compared to the surveillance group (HR 0.89, 95% CI 0.58-1.35; p = 0.58). Conclusions: The administration of AC in patients with MIBC and pT3-T4 residual disease after NAC might have a positive impact on OS and DSS. However, this may not apply to N+ patients.

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