Long-term results of a single-center prospective randomized trial assessing efficacy of a shortened course of adjuvant chemotherapy after radical cystectomy in patients with locally advanced bladder cancer

Zhegalik, A.G.; Polyakov, S.; Rolevich, A.I.; Volkov, A.; Minich, A.; Vasilevich, Vladimir; Mokhort, A.; Krasny, S.; Суконко, О. Г.

doi:10.5173/ceju.2020.0032

Cited by 6 publications

(2 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Importantly, no guidance is available regarding the use of AC in patients with positive STSM due to the dearth of evidence. While a recent meta-analysis using data from 10 randomized controlled trials suggests a 6% absolute survival benefit at five years, those trials utilizing contemporary chemotherapy regimens either excluded or did not report on positive STSM status [ 2 , 4 , 9 , 10 , 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Survival Benefits of Adjuvant Chemotherapy for Positive Soft Tissue Surgical Margins Following Radical Cystectomy in Bladder Cancer with Extravesical Extension

et al. 2023

View full text Add to dashboard Cite

Introduction and Objective: Muscle invasive bladder cancer with extravesical extension is an aggressive disease entity that requires multimodal therapy. The benefits of adjuvant chemotherapy (AC) in patients with a positive soft-tissue surgical margin (STSM), however, are relatively unknown due to exclusion of this population in randomized controlled trials of AC. We sought to define survival benefits in this patient population through our institutional bladder cancer database. Methods: Retrospective review of all patients undergoing radical cystectomy for urothelial carcinoma of the bladder from 2004–2020 with ≥pT3b disease irrespective of neoadjuvant chemotherapy (NAC) use was conducted. Progression-free survival (PFS) and overall survival (OS) estimates were obtained using the Kaplan-Meier method with log-rank test, and the Cox-proportional hazards model was used to identify predictors of improved PFS and OS. AC was defined by any chemotherapy use within 90 days of cystectomy, regardless of STSM status. Results: 476 patients with pT3b disease or worse were identified. Median follow-up was 12.3 months. An amount of 21% of patients were treated with AC. An amount of 24% of patients had positive STSM. Median OS for patients with positive STSM was 8.4 months [95% CI 7–11.5] and 18.3 months [95% CI 15.6–20.8] (p < 0.001) for patients with negative STSM. In the overall cohort, positive STSM (HR 1.93, 95% CI 1.45–2.57, p < 0.001), AC use (HR 0.68, 95% CI 0.51–0.90, p = 0.007), and pN1–3 disease (HR 1.47, 95% CI 1.16–1.87, p = 0.002) were independent predictors of OS when adjusted for performance status, pT-stage, and neoadjuvant chemotherapy use. In patients with positive STSM, median survival was seven months [95% CI 5.2–8.4] without AC, compared to 16.2 months [95% CI 11.5–52.5] with AC (p = 0.0038). For patients with negative STSM, median survival was 17.4 months [95% CI 14–20.1] without AC compared to 22.3 months [95% CI 17.2–36.9] with AC (p = 0.23). In patients with positive STSM, AC use was the only factor associated with an OS benefit with a HR of 0.41 (95% CI 0.21–0.78, p = 0.007). In patients with negative STSM, pT4 and pN1–3 disease were the only factors associated with worse overall survival with a HR of 1.32 (95% CI 1.00–1.74, p = 0.050) and 1.97 (95% CI 1.49–2.60, p < 0.001), respectively. Conclusions: Administration of adjuvant chemotherapy is of particular benefit in patients with positive STSM following radical cystectomy for gross extravesical disease. Positive STSM may be a representative of “early metastatic” or micrometastatic disease.

show abstract

Section: Discussionmentioning

confidence: 99%

Survival Benefits of Adjuvant Chemotherapy for Positive Soft Tissue Surgical Margins Following Radical Cystectomy in Bladder Cancer with Extravesical Extension

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Despite RC and extended PLND is the therapeutic surgical operation, approximately 50% of patients showed very poor prognosis due to distant metastases. Thus, local and systemic therapies must be combined to improve prognosis [20][21][22]. Comparing with cystectomy alone, the neoadjuvant chemoradiotherapy combining with cystectomy has higher 5-year over survival (OS) [23].…”

Section: Discussionmentioning

confidence: 99%

Development and validation of the nomogram for predicting cancer-specific survival in patients with muscle-invasive bladder cancer after radical cystectomy

Wang

Shen

et al. 2022

Preprint

View full text Add to dashboard Cite

Background Accurate survival prediction in muscle-invasive bladder cancer (MIBC) is critical for clinical decision-making. The study aimed to build and validate a practical nomogram to predict the cancer-specific survival (CSS) and assist to formulate clinical-decision for patients with MIBC. Methods The data of 5,474 MIBC patients who underwent radical cystectomy were included from the SEER database between 2004 and 2014. These patients were randomly divided into training cohort and validation cohort with a 7:3 ratio. The nomogram for predicting the CSS was constructed on the basis of univariate and multivariate Cox regression analyses. Kaplan–Meier curves were used to compare the survival patterns in the different subgroups. Finally, the model was assessed by the concordance index (C-index), receiver operating characteristic curve (ROC), area under the curve (AUC) and calibration plot. Results A total of 5,474 patients diagnosed with MIBC were identified and randomized into training (n = 3,832) and validation (n = 1,642) cohort. Multivariate analysis revealed that age, race, T stage, N stage, tumor size, regional nodes positive and neoadjuvant chemotherapy were independent prognostic factors of CSS and were integrated to develop a nomogram for predicting prognosis. Kaplan-Meier curves showed all these variables could influence the prognosis of MIBC patients. The C-indexes of the nomogram were 0.698 (0.685–0.709) in training cohort and 0.685 (0.665–0.705) in validation cohort, respectively. The AUCs of the nomogram were 0.747 for 3-year survival, 0.75 for 5-year survival in the training cohort and 0.742 for 3-year survival, 0.739 for 5-year survival in the validation cohort, respectively. The calibration plots also showed good performance. All the patients were divided into high-risk group and low-risk group based on our model, significant survival difference was also observed between high and low risk groups (P < 0.001). Conclusion We have created a nomogram to predict the cancer-specific survival for MIBC patients underwent radical cystectomy, which may provide a reference for clinical decision-making of postoperative treatment and improve prognosis for individual patients.

show abstract

Adjuvant Chemotherapy for Muscle-invasive Bladder Cancer: A Systematic Review and Meta-analysis of Individual Participant Data from Randomised Controlled Trials

Burdett¹,

Fisher²,

Vale³

et al. 2022

European Urology

View full text Add to dashboard Cite

Long-term results of a single-center prospective randomized trial assessing efficacy of a shortened course of adjuvant chemotherapy after radical cystectomy in patients with locally advanced bladder cancer

Cited by 6 publications

References 17 publications

Survival Benefits of Adjuvant Chemotherapy for Positive Soft Tissue Surgical Margins Following Radical Cystectomy in Bladder Cancer with Extravesical Extension

Survival Benefits of Adjuvant Chemotherapy for Positive Soft Tissue Surgical Margins Following Radical Cystectomy in Bladder Cancer with Extravesical Extension

Development and validation of the nomogram for predicting cancer-specific survival in patients with muscle-invasive bladder cancer after radical cystectomy

Adjuvant Chemotherapy for Muscle-invasive Bladder Cancer: A Systematic Review and Meta-analysis of Individual Participant Data from Randomised Controlled Trials

Contact Info

Product

Resources

About