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| European urology oncology. 2022 Jun 14. pii: S2588-9311(22)00062-1. doi: 10.1016/j.euo.2022.04.001 |
| Selecting the Best Candidates for Cisplatin-based Adjuvant Chemotherapy After Radical Cystectomy Among Patients with pN+ Bladder Cancer. |
| Afferi L1, Lonati C2, Montorsi F3, Briganti A4, Necchi A5, Mari A6, Minervini A7, Tellini R8, Campi R9, Schulz GB10, Black PC11, di Trapani E12, de Cobelli O13, Karnes RJ14, Ahmed M15, Mir MC16, Algarra MA17, Rink M18, Zamboni S19, Mondini F20, Simeone C21, Antonelli A22, Tafuri A23, Krajewski W24, Małkiewicz B25, Xylinas E26, Soria F27, Sanchez Salas R28, Arora A29, Cathelineau X30, Hendricksen K31, Ammiwala M32, Borghesi M33, Chierigo F34, Teoh JY35, Mattei A36, Albisinni S37, Roghmann F38, Roumiguié M39, Bajeot AS40, Maier E41, Aziz A42, Hurle R43, Contieri R44, Pradere B45, Carando R46, Poyet C47, Alvarez-Maestro M48, D'Andrea D49, Shariat SF50, Moschini M51 |
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Abstract A trend towards greater benefit from adjuvant chemotherapy (ACT) in pN+ bladder cancer (BCa) has been observed in multiple randomized controlled trials. However, it is still unclear which patients might benefit the most from this approach. We retrospectively analyzed a multicenter cohort of 1381 patients with pTany pN1-3 cM0 R0 urothelial BCa treated with radical cystectomy (RC) with or without cisplatin-based ACT. The main endpoint was overall survival (OS) after RC. We performed 1:1 propensity score matching to adjust for baseline characteristics and conducted a classification and regression tree (CART) analysis to assess postoperative risk groups and Cox regression analyses to predict OS. Overall, 391 patients (28%) received cisplatin-based ACT. After matching, two cohorts of 281 patients with pN+ BCa were obtained. CART analysis stratified patients into three risk groups: favorable prognosis (≤pT2 and positive lymph node [PLN] count ≤2; odds ratio [OR] 0.43), intermediate prognosis (≥pT3 and PLN count ≤2; OR 0.92), and poor prognosis (pTany and PLN count ≥3; OR 1.36). Only patients with poor prognosis benefitted from ACT in terms of OS (HR 0.51; p < 0.001). We created the first algorithm that stratifies patients with pN+ BCa into prognostic classes and identified patients with pTany BCa with PLN ≥3 as the most suitable candidates for cisplatin-based ACT. PATIENT SUMMARY: We found that overall survival among patients with bladder cancer and evidence of lymph node involvement depends on cancer stage and the number of positive lymph nodes. Patients with more than three nodes affected by metastases seem to experience the greatest overall survival benefit from cisplatin-based chemotherapy after bladder removal. Our study suggests that patients with the highest risk should be prioritized for cisplatin-based chemotherapy after bladder removal. |
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Copyright © 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved. |
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KEYWORDS: Adjuvant chemotherapy, Bladder cancer, Cisplatin, Nodal metastases, Radical cystectomy, Urothelial cancer |
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Publikations ID: 35715319 Quelle: öffnen |
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