Data from the pre-neoadjuvant chemotherapy (NAC) era suggests patients who progress on BCG to muscle-invasive bladder cancer (P-MIBC) exhibit worse outcomes compared to de novo MIBC (D-MIBC). Herein, we investigate whether P-MIBC is an independent poor risk factor in the setting of contemporary NAC use.
A review of patients who underwent radical cystectomy (RC) for cT2-3 MIBC from 2005-2018 was performed. Patients were stratified into high-risk (lymphovascular invasion, variant histology, hydronephrosis, cT3b) vs. low-risk (no risk factors) and P-MIBC (≤pT1 treated with at least induction BCG who progressed to ≥cT2) vs. D-MIBC.
Among 801 patients who underwent RC 20.3% had P-MIBC and 79.7% had D-MIBC. In low-risk patients treated without NAC, P-MIBC was associated with pathologic upstaging (64.9% vs. 42.7%, p=0.004) and worse overall (OS, p=0.006) and cancer-specific survival (CSS, p=0.001) compared to D-MIBC. P-MIBC status conferred uniformly poor survival outcomes to patients who did not receive NAC compared to D-MIBC without NAC (median OS 51.5 months [95% CI 40.0-81.0] vs. 85.1 months [95% CI 62.8-96.0], p=0.040; median CSS not reached, p=0.014). However, P-MIBC status did not remain a negative prognostic factor in the setting of NAC (median OS 90.5 months [95% CI 34.0-not estimable] vs. 87.8 months [95% CI 68.7-not estimable], p=0.606; median CSS not reached, p=0.448).
P-MIBC confers a poor prognosis when managed with RC alone. Treatment with NAC results in equivalent pathologic response and survival outcomes compared to D-MIBC. P-MIBC should be included in risk-stratified approaches to NAC selection.
The Journal of urology. 2021 Jun 29 [Epub ahead of print]
Patrick J Hensley, Kelly K Bree, Matthew T Campbell, Omar Alhalabi, Andrea Kokorovic, Tanner Miest, Graciela M Nogueras-Gonzalez, Jianjun Gao, Arlene O Siefker-Radtke, Charles C Guo, Neema Navai, Colin P Dinney, Ashish M Kamat
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas.