Nonresponse to Neoadjuvant Chemotherapy for Muscle-Invasive Urothelial Cell Carcinoma of the Bladder |
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| Affiliation: | 1. Department of Urology, University of Washington School of Medicine, Seattle, WA;2. Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle, WA;3. Group Health, Seattle, WA;4. University of Utah, Salt Lake City, UT;5. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA;1. Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;2. Clinical Epidemiology and Trials Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;3. Department of Oncology and Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;4. Immunohematology and Transfusion Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;5. Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;6. Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Reseach Center, Rozzano, Italy;7. Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy;8. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy;1. Department of Urology, Ghent University Hospital, Ghent, Belgium;2. Department of Pathology, Ghent University Hospital, Ghent, Belgium;3. Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium;4. Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium;5. Department of Radiology, Ghent University Hospital, Ghent, Belgium;1. IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy;2. Santa Maria della Misericordia Hospital, Udine, Italy;3. CROB, Rionero in Vulture, Italy;4. Santa Maria degli Angeli Hospital, Pordenone, Italy;5. Borgo Trento Hospital, Verona, Italy;6. University Hospital, Modena, Italy;7. Humanitas Hospital, Milano, Italy;8. Oncologia 2 – AOU Careggi, Florence, Italy;9. Versilia Hospital, Lido di Camaiore, Italy;10. IRCCS Azienda Ospedaliera Universitaria San Martino – IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy;11. University Hospital, Ancona, Italy;12. Ca'' Foncello Hospital, Treviso, Italy;13. Spedali Civili, Brescia, Italy;14. Belcolle Hospital, Viterbo, Italy;15. Fazzi Hospital, Lecce, Italy;16. San Salvatore Hospital, Pesaro, Italy;17. Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy;1. Division of General Internal Medicine, University of California-San Francisco, San Francisco, California;2. Department of Nursing, Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California;3. Department of Urology, University of California-San Francisco, San Francisco, California;1. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden;2. Department of Oncology, Karolinska University Hospital, Stockholm, Sweden |
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| Abstract: | BackgroundCisplatin-based neoadjuvant chemotherapy (NC) is commonly used in the treatment of muscle-invasive urothelial cell carcinoma of the bladder (UC) and has been shown to improve survival. However, not all patients respond to NC, thus delaying the interval to potentially curative surgical therapy, risking disease progression and subjecting patients to potential morbidity from NC. In this study, we perform a retrospective analysis of patients who received NC prior to cystectomy to identify factors associated with nonresponse.Patients and MethodsWe identified 80 patients with clinical T2 to T4, N0 to N1 UC of the bladder who received NC and underwent radical cystectomy. Nonresponse was defined as patients with higher pathologic T stage than clinical stage or patients with nodal involvement identified on final pathology.ResultsOverall, 20% of patients were considered nonresponders. In multivariate analysis, age was predictive of nonresponse (Ptrend < .05). Compared with those < 60 years of age, those aged 60 to 69 years (odds ratio [OR], 2.9; 95% CI, 0.7-12) and those aged ≥ 70 (OR, 5.0; 95% CI, 0.9-28) had higher odds of nonresponse. Patients who received gemcitabine-carboplatin had higher odds of nonresponse compared with those who received gemcitabine-cisplatin (OR, 4.4; 95% CI, 0.8-21).ConclusionA subset of patients receiving NC prior to cystectomy will experience disease progression. Future study will need to better identify methods to distinguish individuals more likely to benefit from NC and those that should receive upfront cystectomy. |
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| Keywords: | Cisplatin Cystectomy Muscle-invasive Nonresponse Urothelial cell cancer |
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