PURPOSE - To determine the impact of the timing of radical cystectomy from the diagnosis of muscle-invasive bladder cancer (MIBC) on survival in patients who receive neoadjuvant chemotherapy (NAC) and radical cystectomy.
PATIENTS AND METHODS - We performed a retrospective chart review of consecutive patients with MIBC who received NAC followed by cystectomy between 1996 and 2014 at a single institution. Cox proportional hazards regression models were used to investigate the effect of treatment time intervals on overall survival. Three different treatment time intervals were analyzed for survival impact: from diagnosis of MIBC to initiation of NAC, from initiation of NAC to cystectomy, and from diagnosis to cystectomy. Other pre-treatment as well as post-treatment clinicopathologic parameters were also analyzed.
RESULTS - The median time from the diagnosis of MIBC to radical cystectomy was 28 weeks. Cystectomy performed less than 28 weeks from the diagnosis did not result in significant improvement in overall survival outcomes (HR, 0. 68, 95% CI 0. 28-1. 63; p = 0. 388). Neither the timing of NAC initiation from diagnosis (median 6 weeks) nor the timing of cystectomy from NAC initiation (median 22 weeks) were associated with survival. Patient age, variant histology, extravesical and/or lymph node involvement (T3-4 and/or N≥1) were significantly associated with survival.
CONCLUSIONS - The timing of RC in relation to MIBC diagnosis date does not significantly impact overall survival in MIBC patients receiving NAC.
The Journal of urology. 2015 Nov 17 [Epub ahead of print]
Jong Chul Park, Nilay M Gandhi, Michael A Carducci, Mario A Eisenberger, Alexander S Baras, George J Netto, Jen-Jane Liu, Charles G Drake, Mark P Schoenberg, Trinity J Bivalacqua, Noah M Hahn
Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Department of Oncology, Baltimore, Maryland 21287. , Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Department of Urology, Baltimore, Maryland 21287. , Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Department of Oncology, Baltimore, Maryland 21287; Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Department of Urology, Baltimore, Maryland 21287. , Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Department of Oncology, Baltimore, Maryland 21287; Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Department of Urology, Baltimore, Maryland 21287. , Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Department of Pathology, Baltimore, Maryland 21287. , Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Department of Pathology, Baltimore, Maryland 21287. , Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Department of Urology, Baltimore, Maryland 21287. , Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Department of Oncology, Baltimore, Maryland 21287; Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Department of Urology, Baltimore, Maryland 21287; Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Department of Immunology, Baltimore, Maryland 21287. , Montefiore Medical Center and Albert Einstein College of Medicine, Department of Urology, New York, New York 10461. , Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Department of Urology, Baltimore, Maryland 21287. , Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Department of Oncology, Baltimore, Maryland 21287; Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Department of Urology, Baltimore, Maryland 21287.