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World Journal of Urology

, Volume 37, Issue 1, pp 165–172 | Cite as

Concomitant CIS on TURBT does not impact oncological outcomes in patients treated with neoadjuvant or induction chemotherapy followed by radical cystectomy

  • N. VasdevEmail author
  • H. Zargar
  • J. P. Noël
  • R. Veeratterapillay
  • A. S. Fairey
  • L. S. Mertens
  • C. P. Dinney
  • M. C. Mir
  • L. M. Krabbe
  • M. S. Cookson
  • N. E. Jacobsen
  • N. M. Gandhi
  • J. Griffin
  • J. S. Montgomery
  • E. Y. Yu
  • E. Xylinas
  • N. J. Campain
  • W. Kassouf
  • M. A. Dall’Era
  • J. A. Seah
  • C. E. Ercole
  • S. Horenblas
  • S. S. Sridhar
  • J. S. McGrath
  • J. Aning
  • S. F. Shariat
  • J. L. Wright
  • T. M. Morgan
  • T. J. Bivalacqua
  • S. North
  • D. A. Barocas
  • Y. Lotan
  • P. Grivas
  • A. J. Stephenson
  • J. B. Shah
  • B. W. van Rhijn
  • S. Daneshmand
  • P. E. Spiess
  • J. M. Holzbeierlein
  • A. Thorpe
  • P. C. Black
Original Article

Abstract

Background

Cisplatin-based neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer improves all-cause and cancer specific survival. We aimed to evaluate whether the detection of carcinoma in situ (CIS) at the time of initial transurethral resection of bladder tumor (TURBT) has an oncological impact on the response to NAC prior to radical cystectomy.

Patients and methods

Patients were identified retrospectively from 19 centers who received at least three cycles of NAC or induction chemotherapy for cT2-T4aN0-3M0 urothelial carcinoma of the bladder followed by radical cystectomy between 2000 and 2013. The primary and secondary outcomes were pathological response and overall survival, respectively. Multivariable analysis was performed to determine the independent predictive value of CIS on these outcomes.

Results

Of 1213 patients included in the analysis, 21.8% had concomitant CIS. Baseline clinical and pathologic characteristics of the ‘CIS’ versus ‘no-CIS’ groups were similar. The pathological response did not differ between the two arms when response was defined as pT0N0 (17.9% with CIS vs 21.9% without CIS; p = 0.16) which may indicate that patients with CIS may be less sensitive to NAC or ≤ pT1N0 (42.8% with CIS vs 37.8% without CIS; p = 0.15). On Cox regression model for overall survival for the cN0 cohort, the presence of CIS was not associated with survival (HR 0.86 (95% CI 0.63–1.18; p = 0.35). The presence of LVI (HR 1.41, 95% CI 1.01–1.96; p = 0.04), hydronephrosis (HR 1.63, 95% CI 1.23–2.16; p = 0.001) and use of chemotherapy other than ddMVAC (HR 0.57, 95% CI 0.34–0.94; p = 0.03) were associated with shorter overall survival. For the whole cohort, the presence of CIS was also not associated with survival (HR 1.05 (95% CI 0.82–1.35; p = 0.70).

Conclusion

In this multicenter, real-world cohort, CIS status at TURBT did not affect pathologic response to neoadjuvant or induction chemotherapy. This study is limited by its retrospective nature as well as variability in chemotherapy regimens and surveillance regimens.

Keywords

Neoadjuvant chemotherapy Carcinoma insitu Bladder cancer Radical cystectomy 

Notes

Author contributions

NV: protocol/project development, data collection/management, manuscript writing/editing; HZ: data collection/management, data analysis, manuscript writing/editing; JPN: data collection, manuscript writing/editing; RV: data collection, manuscript review; ASF: data collection, manuscript review; LSM: data collection, manuscript review; CPD: data collection, manuscript review; MCM: data collection, manuscript review; LMK: data collection, manuscript review; MSC: data collection, manuscript review; NEJ: data collection, manuscript review; NMG: data collection, manuscript review; JG: data collection, manuscript review; JSM: data collection, manuscript review; EYY: data collection, manuscript review; EX: data collection, manuscript review; NJC: data collection, manuscript review; WK: data collection, manuscript review; MAD: data collection, manuscript review; JAS: data collection, manuscript review; CEE: data collection, manuscript review; SH: data collection, manuscript review; SSS: data collection, manuscript review; JSM: data collection, manuscript review; JA: data collection, manuscript review; SFS: data collection, manuscript review; JLW: data collection, manuscript review; TMM: data collection, manuscript review; TJB: data collection, manuscript review; SN: data collection, manuscript review; DAB: data collection, manuscript review; YL: data collection, manuscript review; PG: data collection, manuscript review; AJS: data collection, manuscript review; JBS: data collection, manuscript review; BWR: data collection, manuscript review; SD: data collection, manuscript review; PES: data collection, manuscript review; JMH: data collection, manuscript review; AT: manuscript writing/editing; PCB: manuscript writing/editing.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Research involving human participants and animals

For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study where applicable.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • N. Vasdev
    • 1
    • 2
    • 3
    Email author
  • H. Zargar
    • 4
    • 5
    • 6
  • J. P. Noël
    • 1
    • 2
  • R. Veeratterapillay
    • 3
  • A. S. Fairey
    • 8
    • 13
  • L. S. Mertens
    • 9
  • C. P. Dinney
    • 10
  • M. C. Mir
    • 4
    • 5
  • L. M. Krabbe
    • 11
  • M. S. Cookson
    • 12
  • N. E. Jacobsen
    • 13
  • N. M. Gandhi
    • 14
  • J. Griffin
    • 15
  • J. S. Montgomery
    • 16
  • E. Y. Yu
    • 17
  • E. Xylinas
    • 18
  • N. J. Campain
    • 20
  • W. Kassouf
    • 21
  • M. A. Dall’Era
    • 22
  • J. A. Seah
    • 23
  • C. E. Ercole
    • 4
    • 5
  • S. Horenblas
    • 9
  • S. S. Sridhar
    • 23
  • J. S. McGrath
    • 20
  • J. Aning
    • 3
    • 20
  • S. F. Shariat
    • 18
    • 19
  • J. L. Wright
    • 17
  • T. M. Morgan
    • 16
  • T. J. Bivalacqua
    • 14
  • S. North
    • 24
  • D. A. Barocas
    • 25
  • Y. Lotan
    • 11
  • P. Grivas
    • 17
  • A. J. Stephenson
    • 4
    • 5
  • J. B. Shah
    • 10
  • B. W. van Rhijn
    • 9
  • S. Daneshmand
    • 8
  • P. E. Spiess
    • 7
  • J. M. Holzbeierlein
    • 15
  • A. Thorpe
    • 3
  • P. C. Black
    • 6
  1. 1.Department of Urology, Hertfordshire and Bedfordshire Urological Cancer CentreLister HospitalStevenageUK
  2. 2.School of Life and Medical SciencesUniversity of HertfordshireHatfieldUK
  3. 3.Department of UrologyFreeman HospitalNewcastle Upon TyneUK
  4. 4.Department of UrologyRoyal Melbourne HospitalMelbourneAustralia
  5. 5.Department of SurgeryUniversity of MelbourneMelbourneAustralia
  6. 6.Department of Urologic SciencesUniversity of British ColumbiaVancouverCanada
  7. 7.Department of Genitourinary OncologyH. Lee Moffitt Cancer Center and Research InstituteTampaUSA
  8. 8.USC/Norris Comprehensive Cancer Center, Institute of UrologyUniversity of Southern CaliforniaLos AngelesUSA
  9. 9.Department of UrologyThe Netherlands Cancer Institute-Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  10. 10.Department of UrologyMD Anderson Cancer CenterHoustonUSA
  11. 11.Department of UrologyUniversity of Texas Southwestern Medical CenterDallasUSA
  12. 12.Department of UrologyUniversity of Oklahoma College of MedicineOklahoma CityUSA
  13. 13.University of AlbertaEdmontonCanada
  14. 14.Department of UrologyThe Johns Hopkins School of Medicine, The James Buchanan Brady Urological InstituteBaltimoreUSA
  15. 15.Department of Urology, Medical CenterUniversity of KansasKansas CityUSA
  16. 16.Department of UrologyUniversity of Michigan Health SystemAnn ArborUSA
  17. 17.Division of Oncology, Department of MedicineUniversity of Washington School of Medicine and Fred Hutchinson Cancer Research CenterSeattleUSA
  18. 18.Department of Urology, Weill Cornell Medical CollegePresbyterian HospitalNew YorkUSA
  19. 19.Department of UrologyVienna General Hospital, Medical University of ViennaViennaAustria
  20. 20.Department of Surgery, Exeter Surgical Health Services Research UnitRoyal Devon and Exeter NHS TrustExeterUK
  21. 21.(Division of Urology) Department of SurgeryMcGill University Health CenterMontrealCanada
  22. 22.Department of UrologyDavis Medical Center, University of California at DavisSacramentoUSA
  23. 23.Princess Margaret Cancer CenterTorontoCanada
  24. 24.Cross Cancer InstituteEdmontonCanada
  25. 25.Department of Urologic SurgeryVanderbilt University Medical CenterNashvilleUSA

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