A recent study reported that patients with residual urothelial carcinoma of the bladder subsequent to neoadjuvant/induction chemotherapy (NAIC) prior to RC exhibited inferior oncological outcomes in comparison to pathological stage-matched patients who underwent upfront RC.
Our hypothesis is that this may be ascribed to variations in preoperative CT-stage rather than the impact of chemotherapy.
This retrospective multicentre study included 513 patients who underwent RC for cT2-4N0-3M0 disease between 2010 and 2017. Patients were categorized based on pathological outcomes: pathological complete response (pCR, (y)pT0N0), complete downstaging (pCD, (y)pT0/is/a/1N0) and residual muscle-invasive and/or node positive disease (rMIBC, (y)pT2-4N0 and/or (y)pN1-3).
Of the total cohort, 175 (34.1%) patients underwent NAIC+RC, while 338 (65.9%) underwent upfront RC. NAIC+RC patients exhibited lower age and CCI-scores, along with higher cT&N-stage (all P-values < .001). The mOS was 60.5 months for NAIC+RC and 49.4 months for upfront RC (P-value = .171). In patients with rMIBC, survival was inferior after NAIC+RC compared to upfront RC. However, the clinical stage distribution between NAIC+RC and upfront RC was imbalanced, with 3% versus 49% cT2N0 patients and 47% versus 9% cT4b and/or N+ patients, respectively. Following adjustments for cT & N-stage, age, and CCI-scores in multivariable Cox proportional-hazards analysis, worse OS was associated with upfront RC (HR 1.52, [95% CI, 1.11-2.10], P-value = .009).
The observed inferior survival in cT2-4N0-3M0 patients with rMIBC after NAIC+RC compared to those undergoing upfront RC resulted from worse preoperative characteristics, including clinical stage. The representation of clinical disease stage should not be overlooked in survival analyses.
Clinical genitourinary cancer. 2025 Feb 21 [Epub ahead of print]
Daan J Reesink, Charlotte S Voskuilen, Ewoudt M W van de Garde, Kees Hendricksen, Simon Horenblas, Harm H E van Melick, Bas W G van Rhijn
Department of Urology, St. Antonius Hospital Utrecht Nieuwegein, The Netherlands. Electronic address: ., Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Clinical Pharmacy, St. Antonius Hospital Nieuwegein Utrecht, The Netherlands; Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands., Department of Urology, St. Antonius Hospital Utrecht Nieuwegein, The Netherlands., Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/40113474