Association of age with response to preoperative chemotherapy in patients with muscle-invasive bladder cancer

Abstract

Purpose To assess the association of patient age with response to preoperative chemotherapy in patients with muscle-invasive bladder cancer (MIBC). Materials and methods We analyzed data from 1105 patients with MIBC. Patients age was evaluated as continuous variable and stratified in quartiles. Pathologic objective response (pOR; ypT0-Ta-Tis-T1N0) and pathologic complete response (pCR; ypT0N0), as well survival outcomes were assessed. We used data of 395 patients from The Cancer Genome Atlas (TCGA) to investigate the prevalence of TCGA molecular subtypes and DNA damage repair (DDR) gene alterations according to patient age. Results pOR was achieved in 40% of patients. There was no difference in distribution of pOR or pCR between age quartiles. On univariable logistic regression analysis, patient age was not associated with pOR or pCR when evaluated as continuous variables or stratified in quartiles (all p > 0.3). Median follow-up was 18 months (IQR 6–37). On Cox regression and competing risk regression analyses, age was not associated with survival outcomes (all p > 0.05). In the TCGA cohort, patient with age ≤ 60 years has 7% less DDR gene mutations (p = 0.59). We found higher age distribution in patients with luminal (p < 0.001) and luminal infiltrated (p = 0.002) compared to those with luminal papillary subtype. Conclusions While younger patients may have less mutational tumor burden, our analysis failed to show an association of age with response to preoperative chemotherapy or survival outcomes. Therefore, the use of preoperative chemotherapy should be considered regardless of patient age.

Both radiographical and pathological lymph node statuses are independent predictors for survival following neoadjuvant chemotherapy and radical cystectomy for cT3/4 or cN+ bladder cancer

“…We were able to confirm a recent study that the response to inductive chemotherapy in bladder cancer is independent from age [ 23 ]. Discrepant from another trial, we found no association between the number of removed lymph nodes and cancer-specific survival [ 24 ].…”

The Impact of Primary Versus Secondary Muscle-invasive Bladder Cancer at Diagnosis on the Response to Neoadjuvant Chemotherapy

“…All patients were chemotherapy-naïve. We investigated a panel of genes on the basis of prior reports, current ongoing prospective trials, and genes found to have the highest mutation rates in the MSK/The Cancer Genome Atlas (TCGA) cohort [2] , [9] , [12] , [13] , [14] . All data used for this analysis are available at https://cbioportal.org .…”

“…Neoadjuvant chemotherapy (NAC) with a cisplatin-based combination followed by radical cystectomy (RC) is the standard of care for patients with cT2–4N0M0 muscle-invasive bladder cancer (MIBC) who are cisplatin-eligible [1] . Although current evidence supports an overall improvement in survival, not every patient will benefit from NAC [2] , [3] . Patient selection is of paramount importance in order to identify those who will not respond to NAC to avoid NAC toxicity and a delay to definitive therapy.…”