A longitudinal study evaluating interim assessment of neoadjuvant chemotherapy for bladder cancer.

Furrer, Marc A.; Papa, Nathan; Luetolf, Sandro; Roth, Beat; Cumberbatch, Marcus; Dorin Vartolomei, Mihai; Thomas, Benjamin C.; Thoeny, Harriet C.; Seiler, Roland; Thalmann, George N.; Kiss, Bernhard (2021). A longitudinal study evaluating interim assessment of neoadjuvant chemotherapy for bladder cancer. (In Press). BJU international Wiley 10.1111/bju.15579

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OBJECTIVES

To evaluate the usefulness of radiological re-staging after two and four cycles of neoadjuvant chemotherapy (NAC), the impact of re-staging on further patient management, and the correlation between clinical and final pathological tumour stage at radical cystectomy (RC).

PATIENTS AND METHODS

We conducted a longitudinal, single-centre, cohort study of prospectively collected consecutive patients who underwent NAC and RC for urothelial muscle-invasive bladder cancer between July 2001 and December 2017. Patients underwent repeated computed tomography scans for re-staging after two cycles of NAC and after completion of NAC before RC.

RESULTS

Of 180 patients, 110 had ≥four cycles of NAC and had complete imaging available. In the entire cohort, further patient management was only changed in 2/180 patients (1.1%) after two cycles of NAC based on radiological findings. Patients who were stable after two cycles but then downstaged after at least four cycles of NAC had a similarly lowered risk of death (hazard ratio [HR] 0.53). Only one patient downstaged after two cycles was subsequently upstaged after four cycles. Clinical downstaging was observed in 51 patients (46%), 55 patients (50%) had no change in clinical stage and four patients (3.6%) were clinically upstaged. Patients clinically downstaged after four cycles of NAC had a lower risk of death (HR 0.49, 95% confidence interval 0.25-0.94; P = 0.033) compared to those with no change or upstaged after completion of NAC.

CONCLUSIONS

Re-staging of muscle-invasive bladder cancer after two cycles of NAC offers little additional information, rarely changes patient management, and may therefore be omitted, whereas re-staging after completion of NAC by CT is a strong predictor of overall survival.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology

UniBE Contributor:

Furrer, Marc; Lütolf, Sandro; Roth, Beat; Seiler-Blarer, Roland; Thalmann, George and Kiss, Bernhard

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1464-410X

Publisher:

Wiley

Language:

English

Submitter:

Jeannine Wiemann

Date Deposited:

13 Oct 2021 10:45

Last Modified:

13 Oct 2021 10:45

Publisher DOI:

10.1111/bju.15579

PubMed ID:

34418255

Uncontrolled Keywords:

bladder cancer computer tomography imaging neoadjuvant chemotherapy patient management

BORIS DOI:

10.48350/159663

URI:

https://boris.unibe.ch/id/eprint/159663

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