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

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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.

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Author contribution

Parker WP was involved in protocol development, data collection, data analysis and wrote the manuscript. Ho PL was involved in data collection and edited the manuscript. Boorjian SA, Holzbeierlein JM, Kamat AM and Lee EK were involved in protocol development and edited the manuscript. Melquist JJ was involved in data collection and edited the manuscript. Thapa P was involved in data collection, data analysis and edited the manuscript. Frank I edited the manuscript.

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Authors and Affiliations

  1. Department of Urology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    William P. Parker, Stephen A. Boorjian, Prabin Thapa & Igor Frank

  2. Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 1373, Houston, TX, 77030, USA

    Philip L. Ho, Jonathan J. Melquist & Ashish M. Kamat

  3. Department of Urology, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3016, Kansas City, KS, 66160, USA

    Jeffrey M. Holzbeierlein & Eugene K. Lee

Authors
  1. William P. Parker
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  2. Philip L. Ho
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  3. Stephen A. Boorjian
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  4. Jonathan J. Melquist
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  5. Prabin Thapa
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  6. Jeffrey M. Holzbeierlein
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  7. Igor Frank
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  8. Ashish M. Kamat
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  9. Eugene K. Lee
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Corresponding author

Correspondence to Eugene K. Lee.

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Conflict of interest

Ashish M Kamat, MD has the following disclosures: Research Funding—FKD, Heat Biologics, Photocure, Telesta Therapeutics, Merk Abott Molecular, and Pacific Edge. Consulting—Sanofi, Taris, Telesta Therapeutics, Spectrum Pharmaceuticals, Theralase, MDX Health, Merck, Abbott Molecular, Heat Biologics, and Photocure. Advisory Board—Sanofi and Theralase. The authors declare that no other potential conflicts of interest exist.

Ethical statements

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Parker, W.P., Ho, P.L., Boorjian, S.A. et al. The importance of clinical stage among patients with a complete pathologic response at radical cystectomy after neoadjuvant chemotherapy. World J Urol 34, 1561–1566 (2016). https://doi.org/10.1007/s00345-016-1801-y

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  • DOI: https://doi.org/10.1007/s00345-016-1801-y

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