The importance of clinical stage among patients with a complete pathologic response at radical cystectomy after neoadjuvant chemotherapy

William P. Parker, Philip L. Ho, Stephen A. Boorjian, Jonathan J. Melquist, Prabin Thapa, Jeffrey M. Holzbeierlein, Igor Frank, Ashish M. Kamat, Eugene K. Lee

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Purpose: Patients without evidence of disease at radical cystectomy (RC) following neoadjuvant chemotherapy (NAC) have the greatest potential for survival in muscle-invasive bladder cancer. Historically, 15 % of such patients will experience disease recurrence and cancer-specific mortality. We sought to evaluate the effect of pre-treatment clinical factors on the risk of recurrence in patients who were ypT0N0 at RC. Methods: We performed a multi-institutional review of patients treated with NAC + RC for muscle-invasive bladder cancer (≥cT2) without pathologic evidence of disease at surgery (ypT0N0). The association of pre-treatment clinicopathologic features with recurrence was evaluated using Cox proportional hazards. Results: A total of 78 patients were identified with ypT0 disease at RC after NAC. Median postoperative follow-up was 32.4 months (IQR 16.8, 60.0), during which time 17 patients recurred at a median of 6.4 months after RC. Estimated 3-year recurrence-free survival (RFS) of this cohort was 74.8 %. In univariate analysis, cT4 disease (HR 3.12; p = 0.04) and time to RC (HR 1.17 for each month increase; p <0.01) were associated with inferior RFS. Conclusion: Patients without evidence of disease at the time of RC are still at risk of recurrence and death from bladder cancer. Higher clinical stage and increased time to RC were associated with an increased risk of recurrence and subsequent death. These data highlight the importance of timely RC and the continued risk of recurrence in higher clinically staged patients—underscoring the need for close monitoring and patient counseling.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalWorld Journal of Urology
DOIs
StateAccepted/In press - Mar 4 2016

Keywords

  • Bladder cancer
  • Complete response
  • Neoadjuvant chemotherapy
  • Recurrence

ASJC Scopus subject areas

  • Urology

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    Parker, W. P., Ho, P. L., Boorjian, S. A., Melquist, J. J., Thapa, P., Holzbeierlein, J. M., Frank, I., Kamat, A. M., & Lee, E. K. (Accepted/In press). The importance of clinical stage among patients with a complete pathologic response at radical cystectomy after neoadjuvant chemotherapy. World Journal of Urology, 1-6. https://doi.org/10.1007/s00345-016-1801-y