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Minerva Urologica e Nefrologica 2020 Jan 30

DOI: 10.23736/S0393-2249.19.03657-9


lingua: Inglese

Neoadjuvant vs adjuvant chemotherapy for muscle-invasive bladder cancer: a propensity matched analysis

Joshua S. JUE 1 , Tulay KORU-SENGUL 2, 3, Feng MIAO 2, María C. VELÁSQUEZ 1, Luís F. SÁVIO 1, Mahmoud ALAMEDDINE 1, Zachary A. KROEGER 1, Sanoj PUNNEN 1, Dipen J. PAREKH 1, 3, Chad R. RITCH 1, Mark L. GONZALGO 1, 3

1 Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; 2 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; 3 Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA


BACKGROUND: We compared survival outcomes among patients who received either NAC or AC and RC.
METHODS: We identified patients in the National Cancer Data Base (NCDB) diagnosed with clinical T2-T4, N0, M0 urothelial carcinoma who underwent RC. Patients who received NAC were propensity matched by age, race, ethnicity, sex, insurance type, academic/research program, comorbidity, and clinical stage to patients receiving AC within 90 days of RC. Median survival was calculated using Kaplan-Meier analysis. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated from multivariable Cox regression models to compare overall survival (OS), downstaging to non-MIBC (NMIBC), and N upstaging.
RESULTS: A total of 417 patients treated with NAC and 272 patients treated with AC were identified from 2004-2013. Patients who received NAC had better 5 year OS (46.2%, 95% CI: 39.2%-53.0%) compared to patients who received AC (37.6%, 95% CI: 31.5%-43.7%). NAC was a significant predictor of decreased mortality, decreased progression to node positivity, and downstaging to NMIBC (0.76, 0.60-0.96, p=0.023; 0.19, 0.13-0.28, p<0.001; 23.96, 8.91-64.42, p<0.001).
CONCLUSIONS: The use of NAC+RC was associated with improved OS compared to RC+AC for patients diagnosed with T2-T4, N0, M0 bladder cancer. The increased survival benefit associated with NAC compared to AC among patients undergoing RC may be due to decreased progression to node positivity and pathological downstaging.

KEY WORDS: Neoadjuvant chemotherapy; NAC; Adjuvant chemotherapy; AC; Muscle-invasive bladder cancer; Radical cystectomy

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