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World Journal of Urology

, Volume 37, Issue 11, pp 2409–2418 | Cite as

Clinical predictors and survival outcome of patients receiving suboptimal neoadjuvant chemotherapy and radical cystectomy for muscle-invasive bladder cancer: a single-center experience

  • Luca BoeriEmail author
  • Matteo Soligo
  • Igor Frank
  • Stephen A. Boorjian
  • R. Houston Thompson
  • Matthew Tollefson
  • Robert Tarrel
  • Fernando J. Quevedo
  • John C. Cheville
  • R. Jeffrey Karnes
Original Article

Abstract

Purpose

To investigate the prevalence of and factors’ association with receiving suboptimal neoadjuvant chemotherapy (NAC) and its impact on survival outcomes in patients with muscle-invasive bladder cancer (MIBC) treated with radical cystectomy (RC).

Methods

We reviewed 1119 patients treated with NAC and/or RC for cT2-cT4N0M0 BC. Patients were segregated into three groups: (i) suboptimal NAC (received < 3 cycles of cisplatin-based NAC or non-cisplatin-based regimen), (ii) optimal NAC and (iii) no NAC. Clinical characteristics were compared among groups. Logistic regression analyses tested the association between clinical variables and the odds of receiving suboptimal NAC. To adjust for potential baseline confounders, propensity score matching was performed. Pathologic outcomes were compared between groups and Cox regression analyses tested the risk factors associated with recurrence, overall (OM) and cancer-specific mortality (CSM).

Results

Before matching, 84/315 (26.6%) patients received a suboptimal NAC regimen. Lower general health status and impaired renal functions were the most significant factors associated with the administration of a suboptimal NAC. After matching, the optimal NAC group achieved higher rates of complete pathological response as compared to the suboptimal group (p = 0.03). Suboptimal NAC (HR 1.77; p = 0.015) and no NAC (HR 1.52; p = 0.03) were both associated with higher risk of recurrence and OM (HR 1.71; p = 0.02 and HR 1.61; p = 0.02) as compared to optimal NAC.

Conclusion

One out of four MIBC patients received a suboptimal NAC regimen before RC. Receiving a suboptimal NAC regimen was associated with worse disease recurrence and survival outcomes following surgery, as compared to an optimal NAC regimen.

Keywords

Bladder cancer Neoadjuvant chemotherapy Cisplatin Risk factors Survival outcomes 

Notes

Authors’ contribution

LB: Manuscript writing, data analysis. MS, IF, SAB, RHT, MT, RT, FJQ: data collection or management. JCC: data collection or management, project development. RJK: protocol/project development, data collection or management.

Funding

None.

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no potential conflicts of interest.

Ethical approval

This study was approved by the Ethical committee of Mayo Clinic (IRB 18-001622).

Informed consent

Informed consent was obtained from all patients’ parents included in the study.

Supplementary material

345_2019_2689_MOESM1_ESM.xls (1.5 mb)
Supplementary material 1 (XLS 1583 kb)
345_2019_2689_MOESM2_ESM.jpg (48 kb)
Supplementary material 2 (JPEG 47 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Luca Boeri
    • 1
    • 2
    Email author
  • Matteo Soligo
    • 1
  • Igor Frank
    • 1
  • Stephen A. Boorjian
    • 1
  • R. Houston Thompson
    • 1
  • Matthew Tollefson
    • 1
  • Robert Tarrel
    • 1
  • Fernando J. Quevedo
    • 3
  • John C. Cheville
    • 4
  • R. Jeffrey Karnes
    • 1
  1. 1.Department of UrologyMayo ClinicRochesterUSA
  2. 2.Department of UrologyFoundation IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
  3. 3.Department of Medical OncologyMayo ClinicRochesterUSA
  4. 4.Department of Laboratory Medicine and PathologyMayo ClinicRochesterUSA

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