Final Pathologic Stage after Neoadjuvant Chemotherapy and Radical Cystectomy For Bladder Cancer: Does pT0 Predict Better Survival Than pTa/Tis/T1?

Our aim was to assess survival dependent on pathologic response after neoadjuvant chemotherapy (NAC) in a large multicenter patient cohort, with particular focus on the difference between absence of residual cancer (pT0) and the presence of only non-muscle invasive residual cancer (pTa, pTis, pT1).

We retrospectively reviewed records of patients with urothelial cancer who received NAC and underwent radical cystectomy (RC) at 19 contributing institutions from 2000-2013. Patients with cT2-4aN0M0 and eventual pN0 disease were selected for this analysis. Estimated overall survival (OS) was compared between pT0 and pTa/Tis/T1 patients. Multivariable Cox proportional hazards regression model for OS was generated to evaluate hazard ratios (HRs) for variables of interest.

Of 1543 patients undergoing NAC and RC during the study period, 257 were pT0N0 and 207 were pTa/Tis/T1N0. The Kaplan-Meier mean estimates of OS for pT0 and pTa/Tis/T1 patients were 186. 7 mo. (95% CI [145. 9-227. 6]) (median 241. 1) and 138 mo. (95% CI [118. 2-157. 8]) (median 187. 4), respectively (p=0. 58). In the Cox proportional hazards regression model for OS, pTa/Tis/T1N0 status (HR: 0. 36 [95% CI, 0. 23-0. 67]) and pT0N0 status (HR: 0. 28 [95% CI, 0. 17-0. 47]) compared to pT2N0 pathology, positive surgical margin (HR: 1. 75 [95% CI, 1. 07-2. 86]), and receiving MVAC regimen compared to "other" regimen (HR: 0. 45 [95% CI, 0. 27-0. 76]) were predictors of OS.

pTa/Tis/T1N0 and pT0N0 stage on the final cystectomy specimen are strong predictors of survival in patients receiving NAC and RC. We did not discern a statistically significant difference in OS when comparing these two endpoints.

The Journal of urology. 2015 Oct 29 [Epub ahead of print]

Homayoun Zargar, Kamran Zargar-Shoshtari, Yair Lotan, Jay B Shah, Bas W van Rhijn, Siamak Daneshmand, Philippe E Spiess, Peter Black

Vancouver Prostate Centre, Vancouver, BC, Canada. , Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA. , Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. , Department of Urology, MD Anderson Cancer Center, Houston, TX, USA. , Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. , USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, CA, USA. , Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA. , Vancouver Prostate Centre, Vancouver, BC, Canada.  



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