The Promise and Disappointment of Neoadjuvant Chemotherapy and Transurethral Resection for Muscle Invasive Bladder Cancer: Updated Results and Long-Term Followup

Research output: Contribution to journalArticle

Abstract

Introduction: Radical cystectomy with neoadjuvant chemotherapy is the standard of care for patients with localized muscle invasive urothelial carcinoma of the bladder. One of the strongest predictors of survival in these patients is pathological response to initial treatment. Our objective was to determine whether we could stratify the need for radical cystectomy based on pathological response to neoadjuvant chemotherapy. Methods: We present a cohort of patients with muscle invasive urothelial carcinoma of the bladder to whom surveillance and bladder preservation were offered if complete response was achieved following neoadjuvant chemotherapy. Descriptive statistics and survival analysis were performed to assess overall, cancer specific and metastasis-free survival. Patients were stratified based on pathological response to neoadjuvant chemotherapy. Results: A total of 60 patients were included in the cohort, of whom 32 (55%) had absence of residual disease on post-neoadjuvant chemotherapy transurethral resection and 27 (45%) had persistent disease. Of patients undergoing surveillance 52% maintained the bladder without evidence of recurrence. By comparison, of those with recurrence only 20% preserved the bladder and were without evidence of disease. Conclusions: Long-term followup shows a subset of patients achieving good outcomes while preserving the bladder. However, we also observed an inability to reliably identify this subset of patients given current clinical and pathological markers. Until we are able to achieve that goal, the safest oncologic approach remains neoadjuvant chemotherapy followed by radical cystectomy.

Original languageEnglish (US)
Pages (from-to)305-310
Number of pages6
JournalUrology Practice
Volume5
Issue number4
DOIs
StatePublished - Jul 1 2018

Fingerprint

Urinary Bladder Neoplasms
Drug Therapy
Muscles
Urinary Bladder
Cystectomy
Carcinoma
Recurrence
Survival
Standard of Care
Survival Analysis
Biomarkers
Neoplasm Metastasis
Neoplasms

Keywords

  • drug therapy
  • neoadjuvant therapy
  • survival
  • urinary bladder neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

@article{cb404450ecfc49e797b8d113c53f6a4e,
title = "The Promise and Disappointment of Neoadjuvant Chemotherapy and Transurethral Resection for Muscle Invasive Bladder Cancer: Updated Results and Long-Term Followup",
abstract = "Introduction: Radical cystectomy with neoadjuvant chemotherapy is the standard of care for patients with localized muscle invasive urothelial carcinoma of the bladder. One of the strongest predictors of survival in these patients is pathological response to initial treatment. Our objective was to determine whether we could stratify the need for radical cystectomy based on pathological response to neoadjuvant chemotherapy. Methods: We present a cohort of patients with muscle invasive urothelial carcinoma of the bladder to whom surveillance and bladder preservation were offered if complete response was achieved following neoadjuvant chemotherapy. Descriptive statistics and survival analysis were performed to assess overall, cancer specific and metastasis-free survival. Patients were stratified based on pathological response to neoadjuvant chemotherapy. Results: A total of 60 patients were included in the cohort, of whom 32 (55{\%}) had absence of residual disease on post-neoadjuvant chemotherapy transurethral resection and 27 (45{\%}) had persistent disease. Of patients undergoing surveillance 52{\%} maintained the bladder without evidence of recurrence. By comparison, of those with recurrence only 20{\%} preserved the bladder and were without evidence of disease. Conclusions: Long-term followup shows a subset of patients achieving good outcomes while preserving the bladder. However, we also observed an inability to reliably identify this subset of patients given current clinical and pathological markers. Until we are able to achieve that goal, the safest oncologic approach remains neoadjuvant chemotherapy followed by radical cystectomy.",
keywords = "drug therapy, neoadjuvant therapy, survival, urinary bladder neoplasms",
author = "Stanley Yap and Neil Pugashetti and Thenappan Chandrasekar and Marc Dall'Era and Evans, {Christopher P} and Lara, {Primo N} and {deVere White}, {Ralph W}",
year = "2018",
month = "7",
day = "1",
doi = "10.1016/j.urpr.2017.07.001",
language = "English (US)",
volume = "5",
pages = "305--310",
journal = "Urology Practice",
issn = "2352-0779",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - The Promise and Disappointment of Neoadjuvant Chemotherapy and Transurethral Resection for Muscle Invasive Bladder Cancer

T2 - Updated Results and Long-Term Followup

AU - Yap, Stanley

AU - Pugashetti, Neil

AU - Chandrasekar, Thenappan

AU - Dall'Era, Marc

AU - Evans, Christopher P

AU - Lara, Primo N

AU - deVere White, Ralph W

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Introduction: Radical cystectomy with neoadjuvant chemotherapy is the standard of care for patients with localized muscle invasive urothelial carcinoma of the bladder. One of the strongest predictors of survival in these patients is pathological response to initial treatment. Our objective was to determine whether we could stratify the need for radical cystectomy based on pathological response to neoadjuvant chemotherapy. Methods: We present a cohort of patients with muscle invasive urothelial carcinoma of the bladder to whom surveillance and bladder preservation were offered if complete response was achieved following neoadjuvant chemotherapy. Descriptive statistics and survival analysis were performed to assess overall, cancer specific and metastasis-free survival. Patients were stratified based on pathological response to neoadjuvant chemotherapy. Results: A total of 60 patients were included in the cohort, of whom 32 (55%) had absence of residual disease on post-neoadjuvant chemotherapy transurethral resection and 27 (45%) had persistent disease. Of patients undergoing surveillance 52% maintained the bladder without evidence of recurrence. By comparison, of those with recurrence only 20% preserved the bladder and were without evidence of disease. Conclusions: Long-term followup shows a subset of patients achieving good outcomes while preserving the bladder. However, we also observed an inability to reliably identify this subset of patients given current clinical and pathological markers. Until we are able to achieve that goal, the safest oncologic approach remains neoadjuvant chemotherapy followed by radical cystectomy.

AB - Introduction: Radical cystectomy with neoadjuvant chemotherapy is the standard of care for patients with localized muscle invasive urothelial carcinoma of the bladder. One of the strongest predictors of survival in these patients is pathological response to initial treatment. Our objective was to determine whether we could stratify the need for radical cystectomy based on pathological response to neoadjuvant chemotherapy. Methods: We present a cohort of patients with muscle invasive urothelial carcinoma of the bladder to whom surveillance and bladder preservation were offered if complete response was achieved following neoadjuvant chemotherapy. Descriptive statistics and survival analysis were performed to assess overall, cancer specific and metastasis-free survival. Patients were stratified based on pathological response to neoadjuvant chemotherapy. Results: A total of 60 patients were included in the cohort, of whom 32 (55%) had absence of residual disease on post-neoadjuvant chemotherapy transurethral resection and 27 (45%) had persistent disease. Of patients undergoing surveillance 52% maintained the bladder without evidence of recurrence. By comparison, of those with recurrence only 20% preserved the bladder and were without evidence of disease. Conclusions: Long-term followup shows a subset of patients achieving good outcomes while preserving the bladder. However, we also observed an inability to reliably identify this subset of patients given current clinical and pathological markers. Until we are able to achieve that goal, the safest oncologic approach remains neoadjuvant chemotherapy followed by radical cystectomy.

KW - drug therapy

KW - neoadjuvant therapy

KW - survival

KW - urinary bladder neoplasms

UR - http://www.scopus.com/inward/record.url?scp=85047948119&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047948119&partnerID=8YFLogxK

U2 - 10.1016/j.urpr.2017.07.001

DO - 10.1016/j.urpr.2017.07.001

M3 - Article

AN - SCOPUS:85047948119

VL - 5

SP - 305

EP - 310

JO - Urology Practice

JF - Urology Practice

SN - 2352-0779

IS - 4

ER -