BETHESDA, MD USA (UroToday.com) - Introduction: Neoadjuvant chemotherapy (NAC) usage prior to radical cystectomy (RC) is underutilized in part due to concerns of increased surgical complications. Patients undergoing RC are already at high risk for perioperative morbidity, and the impact of NAC on perioperative outcomes is a justified clinical concern. We examined the impact of NAC on 90 day complication, mortality and readmission rates at our institution.
Methods: We identified 315 patients undergoing RC at our institution between 2006 and 2011. Demographic and clinicopathologic variables along with complications (clavien grade ≥ 3), readmissions, and mortality within 90 days were indexed retrospectively. Univariate analysis was performed using chi−square and t−tests where appropriate. Multivariate analysis (MVA) was performed using logistic regression.
Results: Muscle−invasive bladder cancer (MIBC) was the indication for surgery in 234 patients. 79 of 172 patients (46%) with MIBC with eGFR>60 mL/min/1.73m^2 and urothelial cell carcinoma on pre−RC pathology received NAC. Patients undergoing NAC were younger (mean age 65 vs 70 years old, p<0.001) and had lower preoperative hemoglobin (11.8 vs 12.7 g/dL, p < 0.001). They more frequently underwent minimally−invasive surgery (MIS; 24% vs 9%, p < 0.001) although the time period after the commencement of NAC and MIS significantly overlapped. NAC was associated with continent diversions (24% vs 11%, p=0.008). Patients who received NAC were more likely to have non−MIBC final specimens (49% vs 9%, p < 0.001) but the N+ rate was the same (18% vs 18%, p=0.9). There was no difference in readmission (both 21% vs 32%, p=0.08), 90 day mortality (4% vs 7%, p=0.3) or complication rates (25% vs 34%, p=0.14). Median hospital length of stay was 8 days for both groups (mean 10 vs 13 days, p=0.3). On MVA controlling for age, surgical approach and diversion type, indication, and preoperative albumin and hemoglobin, NAC was not an independent predictor of perioperative readmission, complication, or mortality. On MVA, lower preoperative albumin was an independent predictor of complication (OR 0.44, p=0.002) and death (OR 0.42, p=0.01), while a continent diversion was predictive of the need for readmission (OR 4.0, p=0.005).
Conclusion: At our institution, NAC did not confer a higher risk of adverse outcomes within 90 days of RC. As such this consideration should not impact decisions to administer NAC.
Presented by:
Philip Abbosh, MD, PhD1 Timothy Ito, MD1 Reza Mehrazin, MD2 Jeffrey Tomaszewski, MD3 Daniel Canter, MD4 Rosalia Viterbo, MD1 Robert Uzzo, MD1 Marc Smaldone, MD, MSHP1 David Chen, MD1 Alexander Kutikov, MD1 and Richard Greenberg, MD1
1Fox Chase Cancer Center; 2Mount Sinai, Icahn School of Medicine; 3Cooper Medical School of Rowan University; 4Einstein Healthcare Network/Urologic Institute of Southeastern Pennsylvania
Presented at the 2014 Winter Meeting of the Society of Urologic Oncology (SUO) "Defining Excellence in Urologic Oncology" - December 3 - 5, 2014 - Bethesda, MD USA