History of Non-Muscle-Invasive Bladder Cancer May Have a Worse Prognostic Impact in cT2-4aN0M0 Bladder Cancer Patients Treated With Radical Cystectomy

To investigate whether a history of non-muscle-invasive bladder cancer (NMIBC) plays a prognostic role in patients with muscle-invasive bladder cancer (MIBC) treated with radical cystectomy in the era when neoadjuvant chemotherapy was established as standard therapy for MIBC.

A total of 282 patients who were diagnosed with cT2-T4aN0M0 bladder cancer treated with open radical cystectomy at our institutions were included. Initially diagnosed MIBC without a history of NMIBC was defined as primary MIBC group (n = 231), and MIBC that progressed from NMIBC was defined as progressive MIBC (n = 51).

The rate of cT3/4a tumors was significantly higher in the primary MIBC group than in the progressive MIBC group (P = .004). Five-year recurrence-free survival and cancer-specific survival (CSS) rates for the primary MIBC group versus progressive MIBC group were 68.2% versus 55.9% (P = .039) and 76.1% versus 61.6% (P = .005), respectively. Progressive MIBC (hazard ratio, 2.170; P = .008) was independently associated with cancer death. In the primary MIBC group, the 5-year CSS rate in patients treated with neoadjuvant chemotherapy was 85.4%, which was significantly higher than that in patients without (71.5%, P = .023). In the progressive MIBC group, no significant differences were observed in CSS between patients treated with and without neoadjuvant chemotherapy.

MIBC that progressed from NMIBC had a significantly worse clinical outcome than MIBC without a history of NMIBC and may not respond as well to neoadjuvant chemotherapy. These results are informative, even for NMIBC patients treated with conservative intravesical therapy.

Clinical genitourinary cancer. 2018 Apr 28 [Epub ahead of print]

Emina Kayama, Eiji Kikuchi, Keishiro Fukumoto, Suguru Shirotake, Yasumasa Miyazaki, Kyohei Hakozaki, Gou Kaneko, Shunsuke Yoshimine, Nobuyuki Tanaka, Maeda Takahiro, Kunimitsu Kanai, Masafumi Oyama, Yosuke Nakajima, Satoshi Hara, Tetsuo Monma, Mototsugu Oya

Department of Urology, Keio University School of Medicine, Tokyo, Japan., Department of Urology, Keio University School of Medicine, Tokyo, Japan. Electronic address: ., Department of Urology, Saitama Medical University International Medical Center, Saitama, Japan., Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan., Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan., Department of Urology, Saitama City Hospital, Saitama, Japan., Department of Urology, Saiseikai Central Hospital, Tokyo, Japan., Department of Urology, National Hospital Organization, Saitama National Hospital, Saitama, Japan.

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