Predictors of Complete Pathologic Response (pT0) to Neoadjuvant Chemotherapy in Muscle-invasive Bladder Carcinoma

Randomized trials have supported the use of cisplatin-based neoadjuvant chemotherapy (NAC) in muscle-invasive bladder carcinoma (MIBC) owing to the survival advantage, which has correlated with downstaging of the cancer to pT0.

Only 30% to 40% of patients receiving NAC have attained a pT0 response at cystectomy; the remaining have either residual disease or progression. We aimed to identify the factors that could predict a pT0 response to NAC.

Of 336 patients who had undergone robotic cystectomy at our institute from May 2007 to March 2014, we identified 50 patients who had undergone NAC for MIBC. We conducted a retrospective study, dividing these 50 patients into 2 groups, those with and without a pT0. Factors, including age, histologic features, hydronephrosis at initial presentation, and chemotherapy type, were examined by both univariate and multivariate logistic regression analysis.

Of the 50 patients, 14 (28%) had pT0 at cystectomy, 20 (40%) had progressive disease, and 16 (32%) had residual disease. The median age was 67. 5 years, the median glomerular filtration rate at presentation was 87. 5 mL/min, the patients had undergone a median of 3 NAC cycles, and the median time from the end of chemotherapy to surgery was 4 weeks. The odds of a pT0 response for pure urothelial carcinoma (UC) were approximately 11 times greater relative to cancers with transitional cell variant histologic features or mixed tumors (odds ratio 0. 09, 95% confidence interval 0. 021-0. 380; P = . 0011), including squamous, glandular differentiation, small cell, micropapillary, sarcomatoid, nested component, lymphoepithelioma-like, and plasmacytoid variants.

The presence of pure UC favored a pT0 response to NAC compared with those with variant histologic features or mixed tumors. These potential predictors warrant prospective validation to allow the ideal selection of patients for NAC.

Clinical genitourinary cancer. 2015 Oct 03 [Epub ahead of print]

Venkata K Pokuri, Johar R Syed, Zhengyu Yang, Erinn P Field, Susanna Cyriac, Roberto Pili, Ellis Glenn Levine, Gissou Azabdaftari, Donald L Trump, Khurshid Guru, Saby George

Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY. Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, NY. , Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY. , Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, NY. , Department of Pathology, Case Western Reserve University, Cleveland, OH. , Department of Medical Oncology, Indiana University Simon Cancer Center, Indianapolis, IN. , Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY. , Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY. , Department of Medical Oncology, Inova Comprehensive Cancer Research Institute, Falls Church, VA. , Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, NY. , Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY.

PubMed