Risk and predictors of patients receiving neoadjuvant chemotherapy followed by radical cystectomy or transurethral resection alone for muscle-invasive bladder cancer: A single-institute experience
Pei-Jhang Chiang1, Kai-Hsiung Ko2, En Meng1, Tai-Lung Cha3, Guang-Haun Sun1, Dah-Shyong Yu1, Chien-Chang Kao3
1 Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
2 Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
3 Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center; Graduate School of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
Department of Surgery, Division of Urology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Rd, Sec 2, Neihu 114, Taipei
Source of Support: None, Conflict of Interest: None
Context: Upper urinary tract urothelial carcinoma and muscle-invasive bladder cancer (MIBC) incidence rates are high in Taiwan. Our patients with MIBC are commonly managed with a radical cystectomy (RC); however, recurrence rates remain high. Aims: We aimed to establish a protocol regarding neoadjuvant chemotherapy (NAC) followed by RC or transurethral resection (TUR) alone from 2008 to 2013. We outline the efficacy and prognosis of NAC followed by RC. Settings and Design: This was a retrospective study. Subjects and Methods: The clinical data of 38 patients who underwent NAC from 2008 to 2013 at a single institution were retrospectively reviewed. Patients were divided into Group 1 (NAC with RC) and Group 2 (NAC with TUR alone). Age, sex, tumor size, prechemotherapy characteristics, and oncological outcomes were analyzed. Results: Group 1 had worse chemotherapy responses than Group 2 (48% vs. 71%, P = 0.0002). There were no significant differences in the 3-year progression-free survival and overall survival (OS) between the groups. High-risk patients were defined as having a tumor size >5 cm, concurrent hydronephrosis, and adverse pathological features. High-risk Group 1 patients had a better 3-year OS than high-risk Group 2 patients (13/17, 76%; and 3/5, 63%; respectively). Conclusions: In high-risk patients or patients with poor chemotherapy responses, NAC followed by RC with pelvic lymph node dissection resulted in a significantly increased 3-year OS. NAC with TUR alone was suitable only for low-risk patients with good chemotherapy responses.