Oncologic Outcomes for Patients with Residual Cancer at Cystectomy Following Neoadjuvant Chemotherapy: A Pathologic Stage-matched Analysis

Persistent muscle‐invasive bladder cancer after neoadjuvant chemotherapy: an analysis of Surveillance, Epidemiology and End Results‐Medicare data

“…These results are consistent with previous studies showing that tumour downstaging (either by TURBT or NAC) was associated with significantly higher rates of recurrence‐free survival and CSS . For example, a retrospective analysis of 449 patients in the Nordic Cystectomy trials 1 and 2 found complete downstaging (AJCC stage 0, pT0N0M0) in 22.7% of patients who underwent NAC + RC .…”

“…We built on a recent report by Bhindi et al. of 504 stage‐matched patients from a single institution who underwent NAC + RC ( n = 180) vs RC alone ( n = 324). That report found that patients who underwent NAC + RC and had residual urothelial carcinoma of the bladder at the time of RC had a higher rate of death from cancer (40% vs 59%; P = 0.003) and a lower OS rate (33% vs 48%; P = 0.02) than those who underwent RC alone .…”

“…The same analysis showed that patients with tumours that were not downstaged by NAC had a lower survival rate at 5 years than patients who did not undergo NAC, although the difference was not statistically significant . A recent stage‐matched analysis found that patients with residual cancer at the time of RC who underwent NAC had worse oncological outcomes than patients who underwent RC alone .…”

“…Studies with and without NAC have shown a correlation between pathological downstaging at the time of RC and higher rates of survival . According to a post hoc analysis based on the Nordic Cystectomy trials 1 and 2, downstaging by NAC is a surrogate marker for longer survival after RC .…”

Modelling cost‐effectiveness of a biomarker‐based approach to neoadjuvant chemotherapy for muscle‐invasive bladder cancer

“…A recent study found that patients who underwent NAC and were found to still have residual disease at RC had significantly worse 5-year recurrence-free survival (50% vs 63%; P = 0.01), cancer-specific survival (40% vs 59%; P = 0.003), and OS (33% vs 48%; P = 0.02) than pathologically stage-matched controls who underwent RC alone [18]. In the model, we similarly lowered OS in non-responders to biomarker-directed NAC by 31.25%.…”