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Survival after sequential neoadjuvant chemotherapy followed by trimodal treatment or radical cystectomy for muscle-invasive bladder cancer

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Abstract

Purpose

to assess the respective outcomes of patients with localized muscle-invasive bladder cancer (MIBC) treated by either radical cystectomy (RC) or trimodal treatment (TMT) depending on pathological response to previous neoadjuvant chemotherapy (NAC) assessed on cystectomy specimen or post-NAC transurethral resection (TURB) specimen, respectively.

Patient and methods

We retrospectively included all consecutive patients treated in one academic center with cisplatin-based NAC followed by RC or TMT for cT2-3N0M0 MIBC between 2014 and 2021. Primary endpoint was metastasis-free survival (MFS) in both treatment groups and according to pathological response to NAC. Local recurrence-free survival and conservative management failure (metastasis-free bladder-intact survival) for patients treated with TMT were assessed.

Results

104 patients were included, 26 treated with TMT and 78 with RC. The rate of complete pathological response was 47.4% in patients treated with RC (ypT0) and 66.7% in patients treated with TMT (ycT0). Median follow-up was 34.9 months. Four-year MFS was 72% in both treatment groups. Four-year MFS was 85% in both ypT0 RC patients and ycT0 TMT patients. ycT0 stage was associated with low rates of intravesical recurrence and conservative management failure.

Conclusion

Patients with post-NAC ycT0 stage treated with TMT have favorable oncological outcomes similar to those of ypT0 patients treated with RC. Assessment of complete histological response with TURB after NAC may help in selecting the best candidates for bladder preservation with TMT.

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Authors and Affiliations

  1. Urology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France

    Pierre-Louis Reignier, François Desgrandchamps & Alexandra Masson-Lecomte

  2. Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France

    Hélène Gauthier, Quiterie Aussedat, Stéphane Culine & Clément Dumont

  3. Radiotherapy Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France

    Christophe Hennequin

  4. Urology Department, Bichat-Claude Bernard Hospital, AP-HP.Nord Université Paris Cité, Paris, France

    Evanguelos Xylinas

Authors
  1. Pierre-Louis Reignier
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  2. Hélène Gauthier
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  3. Christophe Hennequin
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  4. Quiterie Aussedat
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  5. Evanguelos Xylinas
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  6. François Desgrandchamps
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  7. Stéphane Culine
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  8. Alexandra Masson-Lecomte
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  9. Clément Dumont
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Contributions

P-LR: Protocol & project development, Data collection and management, Manuscript writing & editing. HG: Data collection. CH: Protocol & project development, Data collection and management. QA: Data collection. EX: Data collection. FD: project development, Data collection. SC: Data collection or management. AM-L: Protocol & project development, Data collection and management. CD: Protocol & project development, Data collection and management, Manuscript writing & editing, Data analysis.

Corresponding author

Correspondence to Clément Dumont.

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Conflicts of interest

The authors declare having no competing interest regarding this work.

Research involving human participants and/or animals

Clinical data collection was registered with institutional authorities. This study was conducted in accordance with the Declaration of Helsinki, and approved by the Comité d'Ethique de la Recherche (CER) Paris Nord (Institutional Review Board -IRB 00006477- of HUPNVS, Paris 7 University, AP-HP).

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Patients received written information about this study and could oppose the research use of clinical data as per French regulations.

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Reignier, PL., Gauthier, H., Hennequin, C. et al. Survival after sequential neoadjuvant chemotherapy followed by trimodal treatment or radical cystectomy for muscle-invasive bladder cancer. World J Urol 41, 3249–3255 (2023). https://doi.org/10.1007/s00345-023-04506-9

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  • DOI: https://doi.org/10.1007/s00345-023-04506-9

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