Pd62-01 Comparative Effectiveness of Selective Adjuvant Versus Systematic Neoadjuvant Chemotherapy-based Strategy for Muscle- Invasive Urothelial Carcinoma of the Bladder
Year: 2017
Type: article
Abstract: You have accessJournal of UrologyBladder Cancer: Invasive VI1 Apr 2017PD62-01 COMPARATIVE EFFECTIVENESS OF SELECTIVE ADJUVANT VERSUS SYSTEMATIC NEOADJUVANT CHEMOTHERAPY-BASED STRATEGY FOR MUSCLE- INVASIVE UROTHELIAL CARCINOMA OF THE BLADDER Thomas Seisen, Guru Sonpavde, Naveen Kachroo, Stuart R. Lipsitz, Jeffrey J. Leow, Mani Menon, Philipp Gild, Nicolas von Landenberg, Morgan Rouprêt, Adam S. Kibel, Maxine Sun, Sumanta K. Pal, Joaquim Bellmunt, Toni K. Choueiri, and Quoc-Dien Trinh Thomas SeisenThomas Seisen More articles by this author , Guru SonpavdeGuru Sonpavde More articles by this author , Naveen KachrooNaveen Kachroo More articles by this author , Stuart R. LipsitzStuart R. Lipsitz More articles by this author , Jeffrey J. LeowJeffrey J. Leow More articles by this author , Mani MenonMani Menon More articles by this author , Philipp GildPhilipp Gild More articles by this author , Nicolas von LandenbergNicolas von Landenberg More articles by this author , Morgan RouprêtMorgan Rouprêt More articles by this author , Adam S. KibelAdam S. Kibel More articles by this author , Maxine SunMaxine Sun More articles by this author , Sumanta K. PalSumanta K. Pal More articles by this author , Joaquim BellmuntJoaquim Bellmunt More articles by this author , Toni K. ChoueiriToni K. Choueiri More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2773AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is evidence supporting the use of neoadjuvant (NAC) or adjuvant chemotherapy (AC) in combination with radical cystectomy (RC) for muscle-invasive urothelial carcinoma of the bladder (UCB). However, no study has been devised to compare upfront RC followed - performance status and absence of surgical contraindications permitting - by the selective delivery of AC in patients with adverse pathological features, while watching those with organ-confined disease (selAC-based strategy) vs. the systematic delivery of NAC in all eligible individuals followed by surgery if amenable (sysNAC-based strategy). We hypothesized that a selAC-based strategy is associated with an overall survival (OS) benefit when performing an “intention-to-treat” analysis. METHODS Within the National Cancer Data Base (2003-2011), we identified 10,056 patients who received selAC- vs. sysNAC-based strategy for cT2-T4N0M0 UCB. Inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier and Cox regression analyses with time-varying covariate were used to compare OS of patients who received selAC- vs. sysNAC-based strategy. Exploratory analyses according to baseline characteristics were additionally performed. RESULTS Overall, 8,312 (82.7%) vs. 1,744 (17.3%) patients underwent selAC- vs. sysNAC-based strategy, respectively. IPTW-adjusted Kaplan-Meier curves showed that median OS was significantly longer in the selAC- vs. sysNAC-based strategy group (42.0 [95%CI, 39.5-44.6] vs. 33.7 [95%CI, 29.4-38.1] months; P=0.001). The 5-year IPTW-adjusted rates of OS for selAC- vs. sysNAC-based strategy were 42.98% [95%CI, 41.8-44.2] vs. 37.45% [95%CI, 34.8-40.1], respectively. In IPTW-adjusted Cox regression analyses with time-varying covariate, selAC-based strategy was associated with a significant OS benefit after 17 months of follow-up (HR=0.79; 95%CI=[0.70-0.90]; p<0.001). In exploratory analyses, this benefit was significant in cT2 patients (HR=0.78; 95%CI=[0.67-0.88]; p<0.001) while there was no difference between treatment groups in >=cT3 patients (HR=1.18; 95%CI=[0.95-1.47]; P=0.129). CONCLUSIONS We report an OS benefit for individuals treated with a selAC- vs. sysNAC-based strategy for muscle-invasive UCB - especially cT2 disease. Our findings warrant further consideration in randomized controlled trials to explore this hypothesis. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1193 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Thomas Seisen More articles by this author Guru Sonpavde More articles by this author Naveen Kachroo More articles by this author Stuart R. Lipsitz More articles by this author Jeffrey J. Leow More articles by this author Mani Menon More articles by this author Philipp Gild More articles by this author Nicolas von Landenberg More articles by this author Morgan Rouprêt More articles by this author Adam S. Kibel More articles by this author Maxine Sun More articles by this author Sumanta K. Pal More articles by this author Joaquim Bellmunt More articles by this author Toni K. Choueiri More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Source: The Journal of Urology
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2604154340