Final Pathological Stage after Neoadjuvant Chemotherapy and Radical Cystectomy for Bladder Cancer—Does pT0 Predict Better Survival than pTa/Tis/T1?

Homayoun Zargar, Kamran Zargar-Shoshtari, Yair Lotan, Jay B. Shah, Bas W. van Rhijn, Siamak Daneshmand, Philippe E. Spiess, Peter Black, Adrian S. Fairey, Laura S. Mertens, Simon Horenblas, Colin P. Dinney, Maria C. Mir, Cesar E. Ercole, Andrew J. Stephenson, Laura Maria Krabbe, Michael S. Cookson, Niels Erik Jacobsen, Daniel A. Barocas, Joshua GriffinJeff M. Holzbeierlein, Jeffrey S. Montgomery, Todd M. Morgan, Nikhil Vasdev, Andrew C. Thorpe, Jonathan Aning, Evan Y. Yu, Jonathan L. Wright, Evanguelos Xylinas, Nicholas J. Campain, Farshad Pourmalek, John S. McGrath, Wassim Kassouf, Marc A. Dall'Era, Jo An Seah, Srikala S. Sridhar, Pranav Sharma, Shahrokh F. Shariat, Scott North, Petros Grivas, Nilay Gandhi, Trinity J. Bivalacqua

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Purpose We assessed survival dependent on pathological response after neoadjuvant chemotherapy in a large multicenter patient cohort, with a particular focus on the difference between the absence of residual cancer (pT0) and the presence of only nonmuscle invasive residual cancer (pTa, pTis, pT1). Materials and Methods We retrospectively reviewed records of patients with urothelial cancer who received neoadjuvant chemotherapy and underwent radical cystectomy at 19 contributing institutions from 2000 to 2013. Patients with cT2-4aN0M0 and eventual pN0 disease were selected for this analysis. Estimated overall survival was compared between patients with pT0 and pTa/Tis/T1 disease. A multivariable Cox proportional hazards regression model for overall survival was generated to evaluate hazard ratios for variables of interest. Results Of 1,543 patients treated with neoadjuvant chemotherapy and radical cystectomy during the study period 257 had pT0N0 and 207 had pTa/Tis/T1N0 disease. The Kaplan-Meier mean estimates of overall survival for pT0 and pTa/Tis/T1 cases were 186.7 months (95% CI 145.9–227.6, median 241.1) and 138 months (95% CI 118.2–157.8, median 187.4), respectively (p=0.58). In the Cox proportional hazards regression model for overall survival pTa/Tis/T1N0 status (HR 0.36, 95% CI 0.23–0.67) and pT0N0 status (HR 0.28, 95% CI 0.17–0.47) compared to pT2N0 pathology, positive surgical margin (HR 1.75, 95% CI 1.07–2.86), and receiving a methotrexate, vinblastine, doxorubicin and cisplatin regimen compared to an “other” regimen (HR 0.45, 95% CI 0.27–0.76) were predictors of overall survival. Conclusions pTa/Tis/T1N0 and pT0N0 stage on the final cystectomy specimen are strong predictors of survival in patients treated with neoadjuvant chemotherapy and radical cystectomy. We did not discern a statistically significant difference in overall survival when comparing these 2 end points.

Original languageEnglish (US)
Pages (from-to)886-893
Number of pages8
JournalJournal of Urology
Volume195
Issue number4
DOIs
StatePublished - Apr 1 2016

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Cystectomy
Urinary Bladder
Drug Therapy
Survival
Residual Neoplasm
Proportional Hazards Models
Vinblastine
Kaplan-Meier Estimate
Methotrexate
Doxorubicin
Cisplatin
Pathology

Keywords

  • cystectomy
  • drug therapy
  • neoadjuvant therapy
  • urinary bladder neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Zargar, H., Zargar-Shoshtari, K., Lotan, Y., Shah, J. B., van Rhijn, B. W., Daneshmand, S., ... Bivalacqua, T. J. (2016). Final Pathological Stage after Neoadjuvant Chemotherapy and Radical Cystectomy for Bladder Cancer—Does pT0 Predict Better Survival than pTa/Tis/T1? Journal of Urology, 195(4), 886-893. https://doi.org/10.1016/j.juro.2015.10.133

Final Pathological Stage after Neoadjuvant Chemotherapy and Radical Cystectomy for Bladder Cancer—Does pT0 Predict Better Survival than pTa/Tis/T1? / Zargar, Homayoun; Zargar-Shoshtari, Kamran; Lotan, Yair; Shah, Jay B.; van Rhijn, Bas W.; Daneshmand, Siamak; Spiess, Philippe E.; Black, Peter; Fairey, Adrian S.; Mertens, Laura S.; Horenblas, Simon; Dinney, Colin P.; Mir, Maria C.; Ercole, Cesar E.; Stephenson, Andrew J.; Krabbe, Laura Maria; Cookson, Michael S.; Jacobsen, Niels Erik; Barocas, Daniel A.; Griffin, Joshua; Holzbeierlein, Jeff M.; Montgomery, Jeffrey S.; Morgan, Todd M.; Vasdev, Nikhil; Thorpe, Andrew C.; Aning, Jonathan; Yu, Evan Y.; Wright, Jonathan L.; Xylinas, Evanguelos; Campain, Nicholas J.; Pourmalek, Farshad; McGrath, John S.; Kassouf, Wassim; Dall'Era, Marc A.; Seah, Jo An; Sridhar, Srikala S.; Sharma, Pranav; Shariat, Shahrokh F.; North, Scott; Grivas, Petros; Gandhi, Nilay; Bivalacqua, Trinity J.

In: Journal of Urology, Vol. 195, No. 4, 01.04.2016, p. 886-893.

Research output: Contribution to journalArticle

Zargar, H, Zargar-Shoshtari, K, Lotan, Y, Shah, JB, van Rhijn, BW, Daneshmand, S, Spiess, PE, Black, P, Fairey, AS, Mertens, LS, Horenblas, S, Dinney, CP, Mir, MC, Ercole, CE, Stephenson, AJ, Krabbe, LM, Cookson, MS, Jacobsen, NE, Barocas, DA, Griffin, J, Holzbeierlein, JM, Montgomery, JS, Morgan, TM, Vasdev, N, Thorpe, AC, Aning, J, Yu, EY, Wright, JL, Xylinas, E, Campain, NJ, Pourmalek, F, McGrath, JS, Kassouf, W, Dall'Era, MA, Seah, JA, Sridhar, SS, Sharma, P, Shariat, SF, North, S, Grivas, P, Gandhi, N & Bivalacqua, TJ 2016, 'Final Pathological Stage after Neoadjuvant Chemotherapy and Radical Cystectomy for Bladder Cancer—Does pT0 Predict Better Survival than pTa/Tis/T1?', Journal of Urology, vol. 195, no. 4, pp. 886-893. https://doi.org/10.1016/j.juro.2015.10.133
Zargar, Homayoun ; Zargar-Shoshtari, Kamran ; Lotan, Yair ; Shah, Jay B. ; van Rhijn, Bas W. ; Daneshmand, Siamak ; Spiess, Philippe E. ; Black, Peter ; Fairey, Adrian S. ; Mertens, Laura S. ; Horenblas, Simon ; Dinney, Colin P. ; Mir, Maria C. ; Ercole, Cesar E. ; Stephenson, Andrew J. ; Krabbe, Laura Maria ; Cookson, Michael S. ; Jacobsen, Niels Erik ; Barocas, Daniel A. ; Griffin, Joshua ; Holzbeierlein, Jeff M. ; Montgomery, Jeffrey S. ; Morgan, Todd M. ; Vasdev, Nikhil ; Thorpe, Andrew C. ; Aning, Jonathan ; Yu, Evan Y. ; Wright, Jonathan L. ; Xylinas, Evanguelos ; Campain, Nicholas J. ; Pourmalek, Farshad ; McGrath, John S. ; Kassouf, Wassim ; Dall'Era, Marc A. ; Seah, Jo An ; Sridhar, Srikala S. ; Sharma, Pranav ; Shariat, Shahrokh F. ; North, Scott ; Grivas, Petros ; Gandhi, Nilay ; Bivalacqua, Trinity J. / Final Pathological Stage after Neoadjuvant Chemotherapy and Radical Cystectomy for Bladder Cancer—Does pT0 Predict Better Survival than pTa/Tis/T1?. In: Journal of Urology. 2016 ; Vol. 195, No. 4. pp. 886-893.
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title = "Final Pathological Stage after Neoadjuvant Chemotherapy and Radical Cystectomy for Bladder Cancer—Does pT0 Predict Better Survival than pTa/Tis/T1?",
abstract = "Purpose We assessed survival dependent on pathological response after neoadjuvant chemotherapy in a large multicenter patient cohort, with a particular focus on the difference between the absence of residual cancer (pT0) and the presence of only nonmuscle invasive residual cancer (pTa, pTis, pT1). Materials and Methods We retrospectively reviewed records of patients with urothelial cancer who received neoadjuvant chemotherapy and underwent radical cystectomy at 19 contributing institutions from 2000 to 2013. Patients with cT2-4aN0M0 and eventual pN0 disease were selected for this analysis. Estimated overall survival was compared between patients with pT0 and pTa/Tis/T1 disease. A multivariable Cox proportional hazards regression model for overall survival was generated to evaluate hazard ratios for variables of interest. Results Of 1,543 patients treated with neoadjuvant chemotherapy and radical cystectomy during the study period 257 had pT0N0 and 207 had pTa/Tis/T1N0 disease. The Kaplan-Meier mean estimates of overall survival for pT0 and pTa/Tis/T1 cases were 186.7 months (95{\%} CI 145.9–227.6, median 241.1) and 138 months (95{\%} CI 118.2–157.8, median 187.4), respectively (p=0.58). In the Cox proportional hazards regression model for overall survival pTa/Tis/T1N0 status (HR 0.36, 95{\%} CI 0.23–0.67) and pT0N0 status (HR 0.28, 95{\%} CI 0.17–0.47) compared to pT2N0 pathology, positive surgical margin (HR 1.75, 95{\%} CI 1.07–2.86), and receiving a methotrexate, vinblastine, doxorubicin and cisplatin regimen compared to an “other” regimen (HR 0.45, 95{\%} CI 0.27–0.76) were predictors of overall survival. Conclusions pTa/Tis/T1N0 and pT0N0 stage on the final cystectomy specimen are strong predictors of survival in patients treated with neoadjuvant chemotherapy and radical cystectomy. We did not discern a statistically significant difference in overall survival when comparing these 2 end points.",
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author = "Homayoun Zargar and Kamran Zargar-Shoshtari and Yair Lotan and Shah, {Jay B.} and {van Rhijn}, {Bas W.} and Siamak Daneshmand and Spiess, {Philippe E.} and Peter Black and Fairey, {Adrian S.} and Mertens, {Laura S.} and Simon Horenblas and Dinney, {Colin P.} and Mir, {Maria C.} and Ercole, {Cesar E.} and Stephenson, {Andrew J.} and Krabbe, {Laura Maria} and Cookson, {Michael S.} and Jacobsen, {Niels Erik} and Barocas, {Daniel A.} and Joshua Griffin and Holzbeierlein, {Jeff M.} and Montgomery, {Jeffrey S.} and Morgan, {Todd M.} and Nikhil Vasdev and Thorpe, {Andrew C.} and Jonathan Aning and Yu, {Evan Y.} and Wright, {Jonathan L.} and Evanguelos Xylinas and Campain, {Nicholas J.} and Farshad Pourmalek and McGrath, {John S.} and Wassim Kassouf and Dall'Era, {Marc A.} and Seah, {Jo An} and Sridhar, {Srikala S.} and Pranav Sharma and Shariat, {Shahrokh F.} and Scott North and Petros Grivas and Nilay Gandhi and Bivalacqua, {Trinity J.}",
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TY - JOUR

T1 - Final Pathological Stage after Neoadjuvant Chemotherapy and Radical Cystectomy for Bladder Cancer—Does pT0 Predict Better Survival than pTa/Tis/T1?

AU - Zargar, Homayoun

AU - Zargar-Shoshtari, Kamran

AU - Lotan, Yair

AU - Shah, Jay B.

AU - van Rhijn, Bas W.

AU - Daneshmand, Siamak

AU - Spiess, Philippe E.

AU - Black, Peter

AU - Fairey, Adrian S.

AU - Mertens, Laura S.

AU - Horenblas, Simon

AU - Dinney, Colin P.

AU - Mir, Maria C.

AU - Ercole, Cesar E.

AU - Stephenson, Andrew J.

AU - Krabbe, Laura Maria

AU - Cookson, Michael S.

AU - Jacobsen, Niels Erik

AU - Barocas, Daniel A.

AU - Griffin, Joshua

AU - Holzbeierlein, Jeff M.

AU - Montgomery, Jeffrey S.

AU - Morgan, Todd M.

AU - Vasdev, Nikhil

AU - Thorpe, Andrew C.

AU - Aning, Jonathan

AU - Yu, Evan Y.

AU - Wright, Jonathan L.

AU - Xylinas, Evanguelos

AU - Campain, Nicholas J.

AU - Pourmalek, Farshad

AU - McGrath, John S.

AU - Kassouf, Wassim

AU - Dall'Era, Marc A.

AU - Seah, Jo An

AU - Sridhar, Srikala S.

AU - Sharma, Pranav

AU - Shariat, Shahrokh F.

AU - North, Scott

AU - Grivas, Petros

AU - Gandhi, Nilay

AU - Bivalacqua, Trinity J.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Purpose We assessed survival dependent on pathological response after neoadjuvant chemotherapy in a large multicenter patient cohort, with a particular focus on the difference between the absence of residual cancer (pT0) and the presence of only nonmuscle invasive residual cancer (pTa, pTis, pT1). Materials and Methods We retrospectively reviewed records of patients with urothelial cancer who received neoadjuvant chemotherapy and underwent radical cystectomy at 19 contributing institutions from 2000 to 2013. Patients with cT2-4aN0M0 and eventual pN0 disease were selected for this analysis. Estimated overall survival was compared between patients with pT0 and pTa/Tis/T1 disease. A multivariable Cox proportional hazards regression model for overall survival was generated to evaluate hazard ratios for variables of interest. Results Of 1,543 patients treated with neoadjuvant chemotherapy and radical cystectomy during the study period 257 had pT0N0 and 207 had pTa/Tis/T1N0 disease. The Kaplan-Meier mean estimates of overall survival for pT0 and pTa/Tis/T1 cases were 186.7 months (95% CI 145.9–227.6, median 241.1) and 138 months (95% CI 118.2–157.8, median 187.4), respectively (p=0.58). In the Cox proportional hazards regression model for overall survival pTa/Tis/T1N0 status (HR 0.36, 95% CI 0.23–0.67) and pT0N0 status (HR 0.28, 95% CI 0.17–0.47) compared to pT2N0 pathology, positive surgical margin (HR 1.75, 95% CI 1.07–2.86), and receiving a methotrexate, vinblastine, doxorubicin and cisplatin regimen compared to an “other” regimen (HR 0.45, 95% CI 0.27–0.76) were predictors of overall survival. Conclusions pTa/Tis/T1N0 and pT0N0 stage on the final cystectomy specimen are strong predictors of survival in patients treated with neoadjuvant chemotherapy and radical cystectomy. We did not discern a statistically significant difference in overall survival when comparing these 2 end points.

AB - Purpose We assessed survival dependent on pathological response after neoadjuvant chemotherapy in a large multicenter patient cohort, with a particular focus on the difference between the absence of residual cancer (pT0) and the presence of only nonmuscle invasive residual cancer (pTa, pTis, pT1). Materials and Methods We retrospectively reviewed records of patients with urothelial cancer who received neoadjuvant chemotherapy and underwent radical cystectomy at 19 contributing institutions from 2000 to 2013. Patients with cT2-4aN0M0 and eventual pN0 disease were selected for this analysis. Estimated overall survival was compared between patients with pT0 and pTa/Tis/T1 disease. A multivariable Cox proportional hazards regression model for overall survival was generated to evaluate hazard ratios for variables of interest. Results Of 1,543 patients treated with neoadjuvant chemotherapy and radical cystectomy during the study period 257 had pT0N0 and 207 had pTa/Tis/T1N0 disease. The Kaplan-Meier mean estimates of overall survival for pT0 and pTa/Tis/T1 cases were 186.7 months (95% CI 145.9–227.6, median 241.1) and 138 months (95% CI 118.2–157.8, median 187.4), respectively (p=0.58). In the Cox proportional hazards regression model for overall survival pTa/Tis/T1N0 status (HR 0.36, 95% CI 0.23–0.67) and pT0N0 status (HR 0.28, 95% CI 0.17–0.47) compared to pT2N0 pathology, positive surgical margin (HR 1.75, 95% CI 1.07–2.86), and receiving a methotrexate, vinblastine, doxorubicin and cisplatin regimen compared to an “other” regimen (HR 0.45, 95% CI 0.27–0.76) were predictors of overall survival. Conclusions pTa/Tis/T1N0 and pT0N0 stage on the final cystectomy specimen are strong predictors of survival in patients treated with neoadjuvant chemotherapy and radical cystectomy. We did not discern a statistically significant difference in overall survival when comparing these 2 end points.

KW - cystectomy

KW - drug therapy

KW - neoadjuvant therapy

KW - urinary bladder neoplasms

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