A risk-stratified approach to neoadjuvant chemotherapy in muscle-invasive bladder cancer: implications for patients classified with low-risk disease

Timothy D. Lyon, Igor Frank, Vidit Sharma, Paras H. Shah, Matthew K Tollefson, R. Houston Thompson, R. Jeffrey Karnes, Prabin Thapa, John C. Cheville, Stephen A Boorjian

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Purpose: To validate published risk criteria for informing use of neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC), and to examine outcomes of low-risk (LR) patients treated with immediate radical cystectomy (RC). Methods: We identified 1931 patients who underwent RC for MIBC from 1980 to 2016. Patients were considered high risk (HR) with hydronephrosis, lymphovascular invasion, variant histology and/or cT3/4 disease. Kaplan–Meier survival estimates were compared to patients classified as LR, and logistic regression was used to examine factors associated with pathologic downstaging. Results: A total of 1025 LR and 906 HR patients were identified. Median follow-up was 6.3 years (IQR 2.6–12), during which time 1321 (68%) patients died, 753 (39%) from bladder cancer. HR patients had significantly lower 5-year CSS than LR patients (50% vs. 68%, p = 0.001). Of 561 cisplatin-eligible LR patients treated with RC without NAC, 293 (52%) had pathologic non-organ confined disease; of these, 81 (14%) received adjuvant chemotherapy; 78 (14%) did not due to a perioperative event, while 134 (24%) did not due to patient/provider choice. NAC in LR patients was associated with greater odds of pT0 (OR 3.05; p < 0.001) and < pT2 (OR 2.53; p < 0.001) disease, but was not significantly associated with CSS (p = 0.31). Conclusions: Our results validate the proposed risk groups. Among LR patients treated without NAC, 52% experienced pathologic upstaging, and 14% were unable to receive adjuvant chemotherapy due to a perioperative event. These data support offering NAC to both HR and LR MIBC patients, and may be useful for patient counseling.

Original languageEnglish (US)
JournalWorld Journal of Urology
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • Bladder cancer
  • Neoadjuvant therapy
  • Radical cystectomy

ASJC Scopus subject areas

  • Urology

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    Lyon, T. D., Frank, I., Sharma, V., Shah, P. H., Tollefson, M. K., Thompson, R. H., Karnes, R. J., Thapa, P., Cheville, J. C., & Boorjian, S. A. (Accepted/In press). A risk-stratified approach to neoadjuvant chemotherapy in muscle-invasive bladder cancer: implications for patients classified with low-risk disease. World Journal of Urology. https://doi.org/10.1007/s00345-018-2551-9