Survival Outcomes in Patients With Muscle-Invasive Bladder Cancer Receiving Neoadjuvant Chemotherapy Stratified by Number of Cycles

IF 2.3 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer Pub Date : 2024-09-11 DOI:10.1016/j.clgc.2024.102218

Anumita Chakraborty , Jill Hasler , Elizabeth Handorf , Fern Anari , Pooja Ghatalia , Benjamin Miron , Elizabeth R. Plimack , Daniel M. Geynisman , Matthew Zibelman

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引用次数: 0

Abstract

Introduction

The ≥3 cycles of neoadjuvant cisplatin-based chemotherapy (NAC) are commonly administered to treat MIBC. However, some patients are unable to complete all planned cycles of NAC. Prognosis of patients receiving <3 cycles of NAC has yet to be elucidated.

Methods

This retrospective single-center study quantifies pathologic complete response (pT0N0), recurrence-free survival (RFS), and 5-year overall survival (OS) in patients treated with <3 cycles of NAC compared to ≥3 cycles. Patients with MIBC between 2004 and 2018 receiving at least 1 cycle of cisplatin-based NAC were included. Exclusion criteria were metastasis before initiation of NAC, progression/death during NAC. Patient characteristics were compared using chi-square tests, Fisher's exact tests, and Wilcoxon rank sum tests. Kaplan Meier curves, log-rank tests, and Cox proportional hazards models compared RFS adjusting for patient age, ECOG status, GFR, stage, node positivity, and NAC regimen. 5-year OS was analyzed via logistic regression with the aforementioned patient characteristics in the cohort of patients with 5 years of follow-up, unless deceased prior.

Results

In a cohort of 256 patients, the median RFS was 11.6 months (95% CI 7.79, 28.5) versus 79.5 months (95% CI 62.13, NA) in those receiving ≥3 cycles of NAC. Of 228 patients with documented pathologic stage, complete pathologic response (pT0) was observed in 9.4% of patients receiving <3 cycles, and 27.0% of patients receiving ≥3 cycles of NAC (P = .008). In 195 patients with a minimum of 5 years of follow-up, patients with <3 cycles the 5-year OS was 13.3% with <3 cycles compared to 53.3% with ≥3 cycles of NAC.

Conclusions

In this retrospective, single-center investigation, early cessation of planned NAC was associated with worse pCR rate, RFS, and OS. While further prospective evaluation is required to confirm causality, clinicians should prioritize administering at least 3 cycles of NAC when feasible to optimize outcomes.

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接受新辅助化疗的肌浸润性膀胱癌患者按周期数分层的生存结果

简介以顺铂为基础的新辅助化疗（NAC）≥3个周期是治疗MIBC的常用方法。然而，有些患者无法完成所有计划的新辅助化疗周期。接受化疗的患者预后如何？这项回顾性单中心研究量化了接受 NAC 治疗的患者的病理完全反应（pT0N0）、无复发生存率（RFS）和 5 年总生存率（OS）：在 256 例患者中，接受≥3 个周期 NAC 治疗的患者的中位 RFS 为 11.6 个月（95% CI 7.79，28.5），而接受≥3 个周期 NAC 治疗的患者的中位 RFS 为 79.5 个月（95% CI 62.13，NA）。在 228 例有病理分期记录的患者中，9.4% 接受结论治疗的患者观察到了完全病理反应（pT0）：在这项回顾性单中心调查中，过早停止计划中的 NAC 与较差的 pCR 率、RFS 和 OS 相关。虽然需要进一步的前瞻性评估来确认因果关系，但临床医生应在可行的情况下优先考虑至少 3 个周期的 NAC 治疗，以优化治疗效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical genitourinary cancer 医学-泌尿学与肾脏学

CiteScore

5.20

自引率

6.20%

发文量

201

审稿时长

54 days

期刊介绍： Clinical Genitourinary Cancer is a peer-reviewed journal that publishes original articles describing various aspects of clinical and translational research in genitourinary cancers. Clinical Genitourinary Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of genitourinary cancers. The main emphasis is on recent scientific developments in all areas related to genitourinary malignancies. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.