Does Pathologic Response to Neoadjuvant Chemotherapy Predict Survival in Muscle-Invasive Bladder Cancer Patients? - Expert Commentary

Patients who achieved a pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) have a better prognosis compared to patients with pathologic residual disease (pRD). The clinical value of these pathological responses over the long-term to NAC is not well understood.

A new article published by Waingankar et al. in Urologic Oncology: Seminars and Original Investigations1 examined the impact of NAC pathological response on the anticipated survival (conditional survival) based on the years from the RC. Using the National Cancer Database, the investigators identified patients diagnosed with localized MIBC and treated with NAC and RC between 1998 and 2012. They included 1,533 patients in the study. Of these, 314 patients achieved pCR (pathologic stage of Ta, Tis, or T0 and N0) and 1,239 had pRD patients (≥ pT1 disease and/or ≥pN1). They used Kaplan-Meier analysis to calculate the survival between the two groups and used a Cox proportional hazard model to study the effect of achieving pCR on survival from the time of RC.

During the follow-up period, Patients with pCR had a significantly higher initial probability of survival in year zero (P < 0.001). This effect was sustained in subsequent years. Patients with pCR had improved overall survival relative to those with pRD. As expected, the prognosis for MIBC patients continued to improve with ongoing survivorship, both for patients with pCR and pRD following NAC and RC.

This study adds to the growing literature examining the pCR after NAC as a predictor of overall survival. However, several pathologic and clinical factors affect the accuracy of pCR assessment. Testing this concept in prospective clinical trials is needed to validate pCR as an endpoint for future clinical trials.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York City, New York

Reference: 
1. Waingankar, Nikhil, Rachel Jia, Kathryn E. Marqueen, Francois Audenet, John P. Sfakianos, Reza Mehrazin, Bart S. Ferket, Madhu Mazumdar, and Matthew D. Galsky. "The impact of pathologic response to neoadjuvant chemotherapy on conditional survival among patients with muscle-invasive bladder cancer." In Urologic Oncology: Seminars and Original Investigations. Elsevier, 2019.

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