Correlation of Pathologic Complete Response with Survival After Neoadjuvant Chemotherapy in Bladder Cancer Treated with Cystectomy: A Meta-analysis |
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| Affiliation: | 1. Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy;2. Surgical Department, Urology Unit, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy;1. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA;2. Section of Urology, University of Chicago Medical Center, Chicago, IL, USA;3. Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, TN, USA;4. The VA Tennessee Valley Health Care System, Nashville, TN, USA;5. Division of Urology, San Antonio Military Medical Center, San Antonio, TX, USA;6. Department of Urology, University of Oklahoma College of Medicine, Norman, OK, USA;1. Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY;2. Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, NY;3. Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY;4. Department of Pathology, Case Western Reserve University, Cleveland, OH;5. Department of Medical Oncology, Indiana University Simon Cancer Center, Indianapolis, IN;6. Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY;7. Department of Medical Oncology, Inova Comprehensive Cancer Research Institute, Falls Church, VA;1. Vancouver Prostate Centre, Vancouver, British Columbia, Canada;2. Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida;3. Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas;4. Department of Urology, MD Anderson Cancer Center, Houston, Texas;5. Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;6. USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, California |
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| Abstract: | ContextNeoadjuvant chemotherapy before radical cystectomy (RC) is the preferred initial option for muscle-invasive bladder cancer (BCa). As in rectal and breast cancer, pathologic downstaging is associated with increased overall survival (OS).ObjectiveWe conducted a meta-analysis to determine whether pathologic complete response (pCR) (pT0N0M0) after neoadjuvant chemotherapy is associated with a better outcome in muscle-invasive BCa.Evidence acquisitionA systematic search was conducted in PubMed, Web of Science, Cochrane Collaboration's Central register of controlled trials, and Embase for publications reporting outcomes of patients with and without pCR. All patients underwent neoadjuvant cisplatin-based polychemotherapy and RC. The primary outcome reported as relative risk (RR) was OS. Secondary end points were recurrence-free survival (RFS) and cancer-specific survival other than distant and locoregional RFS. A meta-analysis was performed using the fixed effects model or random effects model. Overall heterogeneity for RFS and OS was assessed with forest plots and the Q test.Evidence synthesisA total of 13 trials were included, for a total of 886 patients analysed after neoadjuvant chemotherapy and RC, without any postoperative treatment. The pCR rate was 28.6%. Patients who achieved pCR in the primary tumour and the lymph nodes presented an RR for OS of 0.45 (95% confidence interval [CI], 0.36–0.56; p < 0.00001). The number needed to treat to prevent 1 death was 3.7 (absolute risk difference: −26%). The summary RR for RFS was 0.19 (95% CI, 0.09–0.39; p < 0.00001).ConclusionsPatients with BCa who achieved pCR (pT0N0M0 stage) after neoadjuvant chemotherapy have a better OS and RFS than do patients without pCR. |
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| Keywords: | Bladder cancer Neoadjuvant chemotherapy pCR Overall survival Prognostic factor |
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