Conservative Management Following Clinical Complete Response to Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Contemporary Outcomes of a Multi-Institutional Cohort Study

We report the outcomes of patients with muscle-invasive bladder cancer from two institutions who experienced a clinical complete response to neoadjuvant platinum-based chemotherapy and opted for active surveillance. It is unknown if conservative management can be safely implemented in these patients.

We performed a retrospective review of patients at Columbia University Medical Center and Memorial Sloan Kettering Cancer Center with muscle-invasive bladder cancer who elected surveillance following a clinical complete response to transurethral resection of bladder tumors and neoadjuvant chemotherapy from 2001-2017. Clinical complete response was defined as absence of tumor on post-chemotherapy transurethral resection of bladder tumors, negative cytology, and normal cross sectional imaging.

Among 148 patients followed for a median of 55 (5-145) months, the five-year disease-specific, overall, cystectomy-free, and recurrence-free survival rates were 90%, 86%, 76%, and 64%. Seventy-one (48%) patients recurred in the bladder-16 (11%) with muscle-invasive disease and 55 (37%) with non-invasive disease. Salvage radical cystectomy prevented cancer-specific death in 9 of 12 (75%) patients who accepted cystectomy after muscle-invasive relapse and 13 of 14 (93%) after non-invasive relapse.

We observed high rates of overall and disease-specific survival with bladder preservation in patients achieving a clinical complete response to neoadjuvant chemotherapy. These outcomes support the safety of active surveillance for carefully selected and closely monitored muscle-invasive bladder cancer patients. Future studies should aim to improve patient selection by identifying biomarkers predictive of invasive relapse and developing novel imaging methods for its early detection.

The Journal of urology. 2018 May 19 [Epub ahead of print]

Patrick Mazza, George W Moran, Gen Li, Dennis J Robins, Justin T Matulay, Harry W Herr, Guarionex J Decastro, James M McKiernan, Christopher B Anderson

Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York. Electronic address: ., Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York. Electronic address: ., Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York. Electronic address: ., Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York. Electronic address: ., Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York. Electronic address: ., Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: ., Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York. Electronic address: ., Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York. Electronic address: ., Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York. Electronic address: .

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