Pathological downstaging following radical cystectomy for muscle-invasive bladder cancer: Survival outcomes in the setting of neoadjuvant chemotherapy versus transurethral resection only

Miguel Cajipe, Hanzhang Wang, Ahmed Elshabrawy, Dharam Kaushik, Michael Liss, Robert Svatek, Shenghui Wu, Wasim H. Chowdhury, Chethan Ramamurthy, Ahmed M. Mansour

Research output: Contribution to journalArticle

Abstract

Introduction: Neoadjuvant chemotherapy (NAC) improves survival for patients undergoing radical cystectomy for muscle-invasive bladder cancer (MIBC). The overall survival (OS) advantage with NAC is primarily seen in patients who achieve pathological downstaging. However, a substantial number of patients achieve pathological downstaging following transurethral resection (TUR) without NAC. Objectives: To analyze the OS outcomes in patients who achieve pathological downstaging in the setting of NAC vs. TUR only. Materials and Methods: We reviewed the National Cancer Database (NCDB) for patients diagnosed with MIBC who underwent radical cystectomy between 2004 and 2014. Patients who achieved complete downstaging (CD) (pT0N0) or noninvasive downstaging (NID) (pT0/Tis/TaN0) were further analyzed. OS was evaluated by comparing those who underwent NAC to those who underwent TUR only. Results: A total of 24,763 patients with MIBC were identified. 1,781 (7.2%) patients had NID and 1,015 (4.1%) had CD. Of all patients, 3,838 (15.5%) underwent NAC. In patients with NID, 757 (42.5%) underwent NAC and 1024 (57.5%) had cystectomy after TUR only. In patients with CD, 465 (45.8%) had NAC, while 550 (54.2%) had TUR only. In both NID and CD, cT2 patients were more likely to have TUR only (P = 0.019, P < 0.001), cT3 patients were more likely to receive NAC (P = 0.008, P < 0.001). Compared to the TUR only group, NAC was associated with improved 5-year OS in those with NID, 77% compared to 68% (HR 0.68, 95% CI [0.52–0.90]), as well as those with CD, 80% vs. 70% (HR 0.59, 95% CI [0.39–0.89]). Conclusions: NAC was associated with significant overall survival benefit in the subset of patients who achieved CD and NID at radical cystectomy. Overall, NAC was underutilized in patients with MIBC.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - Jan 1 2020

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Cystectomy
Urinary Bladder Neoplasms
Drug Therapy
Muscles
Survival
Survival Analysis

Keywords

  • Bladder cancer
  • Neoadjuvant chemotherapy
  • Radical cystectomy

ASJC Scopus subject areas

  • Oncology
  • Urology

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Pathological downstaging following radical cystectomy for muscle-invasive bladder cancer : Survival outcomes in the setting of neoadjuvant chemotherapy versus transurethral resection only. / Cajipe, Miguel; Wang, Hanzhang; Elshabrawy, Ahmed; Kaushik, Dharam; Liss, Michael; Svatek, Robert; Wu, Shenghui; Chowdhury, Wasim H.; Ramamurthy, Chethan; Mansour, Ahmed M.

In: Urologic Oncology: Seminars and Original Investigations, 01.01.2020.

Research output: Contribution to journalArticle

Cajipe, Miguel ; Wang, Hanzhang ; Elshabrawy, Ahmed ; Kaushik, Dharam ; Liss, Michael ; Svatek, Robert ; Wu, Shenghui ; Chowdhury, Wasim H. ; Ramamurthy, Chethan ; Mansour, Ahmed M. / Pathological downstaging following radical cystectomy for muscle-invasive bladder cancer : Survival outcomes in the setting of neoadjuvant chemotherapy versus transurethral resection only. In: Urologic Oncology: Seminars and Original Investigations. 2020.
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abstract = "Introduction: Neoadjuvant chemotherapy (NAC) improves survival for patients undergoing radical cystectomy for muscle-invasive bladder cancer (MIBC). The overall survival (OS) advantage with NAC is primarily seen in patients who achieve pathological downstaging. However, a substantial number of patients achieve pathological downstaging following transurethral resection (TUR) without NAC. Objectives: To analyze the OS outcomes in patients who achieve pathological downstaging in the setting of NAC vs. TUR only. Materials and Methods: We reviewed the National Cancer Database (NCDB) for patients diagnosed with MIBC who underwent radical cystectomy between 2004 and 2014. Patients who achieved complete downstaging (CD) (pT0N0) or noninvasive downstaging (NID) (pT0/Tis/TaN0) were further analyzed. OS was evaluated by comparing those who underwent NAC to those who underwent TUR only. Results: A total of 24,763 patients with MIBC were identified. 1,781 (7.2{\%}) patients had NID and 1,015 (4.1{\%}) had CD. Of all patients, 3,838 (15.5{\%}) underwent NAC. In patients with NID, 757 (42.5{\%}) underwent NAC and 1024 (57.5{\%}) had cystectomy after TUR only. In patients with CD, 465 (45.8{\%}) had NAC, while 550 (54.2{\%}) had TUR only. In both NID and CD, cT2 patients were more likely to have TUR only (P = 0.019, P < 0.001), cT3 patients were more likely to receive NAC (P = 0.008, P < 0.001). Compared to the TUR only group, NAC was associated with improved 5-year OS in those with NID, 77{\%} compared to 68{\%} (HR 0.68, 95{\%} CI [0.52–0.90]), as well as those with CD, 80{\%} vs. 70{\%} (HR 0.59, 95{\%} CI [0.39–0.89]). Conclusions: NAC was associated with significant overall survival benefit in the subset of patients who achieved CD and NID at radical cystectomy. Overall, NAC was underutilized in patients with MIBC.",
keywords = "Bladder cancer, Neoadjuvant chemotherapy, Radical cystectomy",
author = "Miguel Cajipe and Hanzhang Wang and Ahmed Elshabrawy and Dharam Kaushik and Michael Liss and Robert Svatek and Shenghui Wu and Chowdhury, {Wasim H.} and Chethan Ramamurthy and Mansour, {Ahmed M.}",
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T1 - Pathological downstaging following radical cystectomy for muscle-invasive bladder cancer

T2 - Survival outcomes in the setting of neoadjuvant chemotherapy versus transurethral resection only

AU - Cajipe, Miguel

AU - Wang, Hanzhang

AU - Elshabrawy, Ahmed

AU - Kaushik, Dharam

AU - Liss, Michael

AU - Svatek, Robert

AU - Wu, Shenghui

AU - Chowdhury, Wasim H.

AU - Ramamurthy, Chethan

AU - Mansour, Ahmed M.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Introduction: Neoadjuvant chemotherapy (NAC) improves survival for patients undergoing radical cystectomy for muscle-invasive bladder cancer (MIBC). The overall survival (OS) advantage with NAC is primarily seen in patients who achieve pathological downstaging. However, a substantial number of patients achieve pathological downstaging following transurethral resection (TUR) without NAC. Objectives: To analyze the OS outcomes in patients who achieve pathological downstaging in the setting of NAC vs. TUR only. Materials and Methods: We reviewed the National Cancer Database (NCDB) for patients diagnosed with MIBC who underwent radical cystectomy between 2004 and 2014. Patients who achieved complete downstaging (CD) (pT0N0) or noninvasive downstaging (NID) (pT0/Tis/TaN0) were further analyzed. OS was evaluated by comparing those who underwent NAC to those who underwent TUR only. Results: A total of 24,763 patients with MIBC were identified. 1,781 (7.2%) patients had NID and 1,015 (4.1%) had CD. Of all patients, 3,838 (15.5%) underwent NAC. In patients with NID, 757 (42.5%) underwent NAC and 1024 (57.5%) had cystectomy after TUR only. In patients with CD, 465 (45.8%) had NAC, while 550 (54.2%) had TUR only. In both NID and CD, cT2 patients were more likely to have TUR only (P = 0.019, P < 0.001), cT3 patients were more likely to receive NAC (P = 0.008, P < 0.001). Compared to the TUR only group, NAC was associated with improved 5-year OS in those with NID, 77% compared to 68% (HR 0.68, 95% CI [0.52–0.90]), as well as those with CD, 80% vs. 70% (HR 0.59, 95% CI [0.39–0.89]). Conclusions: NAC was associated with significant overall survival benefit in the subset of patients who achieved CD and NID at radical cystectomy. Overall, NAC was underutilized in patients with MIBC.

AB - Introduction: Neoadjuvant chemotherapy (NAC) improves survival for patients undergoing radical cystectomy for muscle-invasive bladder cancer (MIBC). The overall survival (OS) advantage with NAC is primarily seen in patients who achieve pathological downstaging. However, a substantial number of patients achieve pathological downstaging following transurethral resection (TUR) without NAC. Objectives: To analyze the OS outcomes in patients who achieve pathological downstaging in the setting of NAC vs. TUR only. Materials and Methods: We reviewed the National Cancer Database (NCDB) for patients diagnosed with MIBC who underwent radical cystectomy between 2004 and 2014. Patients who achieved complete downstaging (CD) (pT0N0) or noninvasive downstaging (NID) (pT0/Tis/TaN0) were further analyzed. OS was evaluated by comparing those who underwent NAC to those who underwent TUR only. Results: A total of 24,763 patients with MIBC were identified. 1,781 (7.2%) patients had NID and 1,015 (4.1%) had CD. Of all patients, 3,838 (15.5%) underwent NAC. In patients with NID, 757 (42.5%) underwent NAC and 1024 (57.5%) had cystectomy after TUR only. In patients with CD, 465 (45.8%) had NAC, while 550 (54.2%) had TUR only. In both NID and CD, cT2 patients were more likely to have TUR only (P = 0.019, P < 0.001), cT3 patients were more likely to receive NAC (P = 0.008, P < 0.001). Compared to the TUR only group, NAC was associated with improved 5-year OS in those with NID, 77% compared to 68% (HR 0.68, 95% CI [0.52–0.90]), as well as those with CD, 80% vs. 70% (HR 0.59, 95% CI [0.39–0.89]). Conclusions: NAC was associated with significant overall survival benefit in the subset of patients who achieved CD and NID at radical cystectomy. Overall, NAC was underutilized in patients with MIBC.

KW - Bladder cancer

KW - Neoadjuvant chemotherapy

KW - Radical cystectomy

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