Neoadjuvant chemotherapy before radical cystectomy in patients with organ-confined and non-organ-confined urothelial carcinoma

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations Pub Date : 2024-10-18 DOI:10.1016/j.urolonc.2024.09.015

Mario de Angelis M.D. , Letizia Maria Ippolita Jannello M.D. , Carolin Siech M.D. , Andrea Baudo M.D. , Francesco Di Bello M.D. , Jordan A. Goyal , Zhe Tian M.Sc , Nicola Longo M.D. , Ottavio de Cobelli M.D. , Felix K.H. Chun M.D. , Fred Saad M.D., Ph.D. , Shahrokh F. Shariat M.D., Ph.D. , Luca Carmignani M.D. , Giorgio Gandaglia M.D. , Marco Moschini M.D., Ph.D. , Francesco Montorsi M.D. , Alberto Briganti M.D., Ph.D. , Pierre I. Karakiewicz M.D.

{"title":"Neoadjuvant chemotherapy before radical cystectomy in patients with organ-confined and non-organ-confined urothelial carcinoma","authors":"Mario de Angelis M.D. , Letizia Maria Ippolita Jannello M.D. , Carolin Siech M.D. , Andrea Baudo M.D. , Francesco Di Bello M.D. , Jordan A. Goyal , Zhe Tian M.Sc , Nicola Longo M.D. , Ottavio de Cobelli M.D. , Felix K.H. Chun M.D. , Fred Saad M.D., Ph.D. , Shahrokh F. Shariat M.D., Ph.D. , Luca Carmignani M.D. , Giorgio Gandaglia M.D. , Marco Moschini M.D., Ph.D. , Francesco Montorsi M.D. , Alberto Briganti M.D., Ph.D. , Pierre I. Karakiewicz M.D.","doi":"10.1016/j.urolonc.2024.09.015","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) is guideline-recommended in patients with cT2-T4N0M0 urothelial carcinoma of urinary bladder (UCUB). However, no population-based study validated the survival benefit of NAC recorded in clinical trials in a stage-specific fashion. We addressed this knowledge gap.</div></div><div><h3>Methods</h3><div>Within the Surveillance, Epidemiology, and End Results database (2007–2020), we identified patients with cT2-T4N0M0 UCUB treated with NAC before RC versus RC alone. Cumulative incidence plots and multivariable competing risks regression (CRR) models were fitted. Survival analyses were performed according to organ confined (OC: cT2N0M0) versus nonorgan confined stages (NOC: cT3-T4N0M0).</div></div><div><h3>Results</h3><div>Of 3,743 assessable patients, 1,020 (27%) underwent NAC versus 2,723 (73%) RC alone. NAC rates increased over time in OC stage (EAPC = 11.9%, <em>P</em> < 0.001) and NOC stage (EAPC = 8.6%, <em>P</em> < 0.001). In OC stage, cumulative incidence plots derived 5-year CSM was 15.6% in NAC and 19.9% in RC alone patients (<em>P</em> = 0.008). In multivariable CRR models, NAC independently predicted lower CSM (hazard ratio (HR): 0.74, <em>P</em> = 0.01). Similarly, in NOC stage, cumulative incidence plots derived 5-year CSM was 36.1% in NAC and 46.0% in RC alone patients (<em>P</em> = 0.01). In multivariable CRR models, NAC independently predicted lower CSM (HR: 0.66, <em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>NAC is associated with improved CSM compared to RC alone, both in OC and NOC stages. Specifically, the magnitude of the protective NAC effect was greater in NOC than OC patients. Thus, NAC should always be administered in all eligible patients before RC.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 1","pages":"Pages 62.e1-62.e6"},"PeriodicalIF":2.4000,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urologic Oncology-seminars and Original Investigations","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1078143924006562","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) is guideline-recommended in patients with cT2-T4N0M0 urothelial carcinoma of urinary bladder (UCUB). However, no population-based study validated the survival benefit of NAC recorded in clinical trials in a stage-specific fashion. We addressed this knowledge gap.

Methods

Within the Surveillance, Epidemiology, and End Results database (2007–2020), we identified patients with cT2-T4N0M0 UCUB treated with NAC before RC versus RC alone. Cumulative incidence plots and multivariable competing risks regression (CRR) models were fitted. Survival analyses were performed according to organ confined (OC: cT2N0M0) versus nonorgan confined stages (NOC: cT3-T4N0M0).

Results

Of 3,743 assessable patients, 1,020 (27%) underwent NAC versus 2,723 (73%) RC alone. NAC rates increased over time in OC stage (EAPC = 11.9%, P < 0.001) and NOC stage (EAPC = 8.6%, P < 0.001). In OC stage, cumulative incidence plots derived 5-year CSM was 15.6% in NAC and 19.9% in RC alone patients (P = 0.008). In multivariable CRR models, NAC independently predicted lower CSM (hazard ratio (HR): 0.74, P = 0.01). Similarly, in NOC stage, cumulative incidence plots derived 5-year CSM was 36.1% in NAC and 46.0% in RC alone patients (P = 0.01). In multivariable CRR models, NAC independently predicted lower CSM (HR: 0.66, P < 0.001).

Conclusion

NAC is associated with improved CSM compared to RC alone, both in OC and NOC stages. Specifically, the magnitude of the protective NAC effect was greater in NOC than OC patients. Thus, NAC should always be administered in all eligible patients before RC.

查看原文本刊更多论文

器官封闭型和非器官封闭型尿路上皮癌患者根治性膀胱切除术前的新辅助化疗。

导言：指南推荐 cT2-T4N0M0 尿路上皮癌（UCUB）患者在接受根治性膀胱切除术（RC）前接受新辅助化疗（NAC）。然而，还没有一项基于人群的研究以特定阶段的方式验证了临床试验中记录的 NAC 的生存益处。我们填补了这一知识空白：方法：在监测、流行病学和最终结果数据库（2007-2020 年）中，我们确定了 cT2-T4N0M0 UCUB 患者在 RC 前接受 NAC 治疗与仅接受 RC 治疗的对比。我们拟合了累积发病率图和多变量竞争风险回归（CRR）模型。根据器官局限期（OC：cT2N0M0）与非器官局限期（NOC：cT3-T4N0M0）进行生存分析：在3743例可评估的患者中，1020例（27%）接受了NAC治疗，而2723例（73%）仅接受了RC治疗。OC期（EAPC = 11.9%，P < 0.001）和NOC期（EAPC = 8.6%，P < 0.001）的NAC率随时间推移而增加。在 OC 阶段，累积发病率图得出的 5 年 CSM 在 NAC 患者中为 15.6%，在单用 RC 患者中为 19.9%（P = 0.008）。在多变量 CRR 模型中，NAC 可独立预测较低的 CSM（危险比 (HR)：0.74，P = 0.01）。同样，在 NOC 阶段，累积发病率图得出的 5 年 CSM 在 NAC 患者中为 36.1%，仅在 RC 患者中为 46.0%（P = 0.01）。在多变量 CRR 模型中，NAC 可独立预测较低的 CSM（HR：0.66，P <0.001）：结论：与单纯 RC 相比，NAC 可改善 OC 和 NOC 阶段的 CSM。结论：无论是在 OC 还是在 NOC 阶段，NAC 都能改善 CSM。因此，所有符合条件的患者在进行 RC 之前都应服用 NAC。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Urologic Oncology-seminars and Original Investigations 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.70%

发文量

297

审稿时长

7.6 weeks

期刊介绍： Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.