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Pederzoli F , Bandini M , Briganti A , Plimack ER , Niegisch G , Yu EY , Bamias A , Agarwal N , Sridhar SS , Sternberg CN , Vaishampayan UN , Theodore C , Rosenberg JE , Harshman LC , Bellmunt J , Galsky MD , Gallina A , Salonia A , Montorsi F , Necchi A
Incremental Utility of Adjuvant Chemotherapy in Muscle-invasive Bladder Cancer: Quantifying the Relapse Risk Associated with Therapeutic Effect
Eur Urol. 2019 Oct;76(4) :425-429
PMID: 31303258    PMCID: PMC6852645    URL: https://www.ncbi.nlm.nih.gov/pubmed/31303258
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Abstract
The availability of new potent systemic therapies for urothelial carcinoma may change the way we use standard chemotherapy perioperatively. In particular, identifying which patients with muscle-invasive bladder cancer (MIBC) would benefit from adjuvant chemotherapy (AC) is compelling. From a multicenter database we selected 950 patients with cT2-4N0M0 MIBC treated with radical cystectomy (RC), with or without neoadjuvant chemotherapy (NAC), and AC. We used Kaplan-Meier analyses to test 1-yr recurrence-free survival (RFS) rates according to AC use. Nomogram-derived probabilities of 1-yr recurrence after RC were plotted against actual recurrence rates according to AC use. Overall, we did not see evidence of an AC effect on the 1-yr RFS rate (p=0.6). Conversely, the 1-yr RFS rate was higher among patients with pT3-4 or pN1 disease who received AC (75% vs 54%; p<0.001). We were unable to demonstrate a difference between AC and no AC among patients who received prior NAC (1-yr RFS 57% vs 76%; p=0.057). As the most important finding, AC was associated with incremental RFS benefits only for patients with a nomogram-derived 1-yr recurrence probability of >40%. Patient summary: Maximizing disease control with adjuvant chemotherapy was beneficial for patients with muscle-invasive bladder cancer who had a calculated recurrence risk of >40% and did not impact cancer recurrence in lower-risk disease. Therefore, patient stratification using the nomogram available for predicting recurrence is advisable pending external validation.
Notes
1873-7560 Pederzoli, Filippo Bandini, Marco Briganti, Alberto Plimack, Elizabeth R Niegisch, Gunter Yu, Evan Y Bamias, Aristotelis Agarwal, Neeraj Sridhar, Srikala S Sternberg, Cora N Vaishampayan, Ulka N Theodore, Christine Rosenberg, Jonathan E Harshman, Lauren C Bellmunt, Joaquim Galsky, Matthew D Gallina, Andrea Salonia, Andrea Montorsi, Francesco Necchi, Andrea RISC Investigators Journal Article Switzerland Eur Urol. 2019 Oct;76(4):425-429. doi: 10.1016/j.eururo.2019.06.032. Epub 2019 Jul 11.