Oncological outcomes of neoadjuvant chemotherapy in muscle-invasive bladder cancer in Rajavithi Hospital
DOI:
https://doi.org/10.52786/isu.a.96Keywords:
Neoadjuvant chemotherapy, radical cystectomy, urothelial bladder cancer, muscle-invasive bladder cancer, pathological responseAbstract
Objective: Neoadjuvant chemotherapy (NAC) can provide better survival benefits than radical cystectomy (RC) alone in patients with muscle-invasive bladder cancer (MIBC). At Rajavithi Hospital neoadjuvant chemotherapy has been used with some patients diagnosed with MIBC and in this study the oncologic outcomes have been evaluated. The precise objectives of this study are to assess the outcomes, overall survival, and factors which show a correlation with a downstaging of neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer before radical cystectomy at Rajavithi Hospital.
Materials and Methods: This is a single-center, retrospective case control study conducted at this large public hospital in Thailand. Forty patients (31 males, 9 females) were enrolled onto the study and had been diagnosed with MIBC. All had received neoadjuvant chemotherapy before undergoing radical cystectomy from January 2012 to December 2020. The primary endpoint was to assess the pathologic complete response (pCR) rate in MIBC after treatment with neoadju- vant chemotherapy. The secondary endpoints were overall survival (OS), tumor downstaging, and factors correlated with downstaging following NAC.
Results: The overall complete response rate for all patients was 7.50%. Tumor downstaging occurred in 47.50% of patients, upstaging in 22.50%, and no change in 30.00%. At a median follow-up period of 35 months, the overall survival (OS) rate was 52.80%.
Conclusion: The complete response rate and overall survival were lower than those reported in previous studies. This may be due to the primary regimen being gemcitabine and carboplatin rather than one of the other pharmaceutical combinations, and also patients not completing the full course of neoadjuvant chemotherapy. We found a correlation between non-response and chronic kidney disease (CKD), positive lymphovascular invasion (LVI), and positive pelvic lymph nodes. A correlation between non-response and mortality was also found.
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