Impact of Adjuvant Chemotherapy on Survival of Patients with Advanced Residual Disease at Radical Cystectomy following Neoadjuvant Chemotherapy: Systematic Review and Meta-Analysis
Por:
Krajewski, W, Nowak, L, Moschini, M, Poletajew, S, Chorbinska, J, Necchi, A, Montorsi, F, Briganti, A, Sanchez-Salas, R, Shariat, SF, Palou, J, Babjuk, M, Teoh, JY, Soria, F, Pradere, B, Ornaghi, PI, Pawlak, A, Dembowski, J, Zdrojowy, R
Publicada:
1 feb 2021
Resumen:
Background: Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) with pelvic lymph-node dissection is the standard treatment for cT2-4a cN0 cM0 muscle-invasive bladder cancer (MIBC). Despite the significant improvement of primary-tumor downstaging with NAC, up to 50% of patients are eventually found to have advanced residual disease (pT3-T4 and/or histopathologically confirmed nodal metastases (pN+)) at RC. Currently, there is no established standard of care in such cases. The aim of this systematic review and meta-analysis was to assess differences in survival rates between patients with pT3-T4 and/or pN+ MIBC who received NAC and surgery followed by adjuvant chemotherapy (AC), and patients without AC. Materials and Methods: A systematic search was conducted in accordance with the PRISMA statement using the Medline, Embase, and Cochrane Library databases. The last search was performed on 12 November 2020. The primary end point was overall survival (OS) and the secondary end point was disease-specific survival (DSS). Results: We identified 2124 articles, of which 6 were selected for qualitative and quantitative analyses. Of a total of 3096 participants in the included articles, 2355 (76.1%) were in the surveillance group and 741 (23.9%) received AC. The use of AC was associated with significantly better OS (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.75-0.94; p = 0.002) and DSS (HR 0.56, 95% CI 0.32-0.99; p = 0.05). Contrary to the main analysis, in the subgroup analysis including only patients with pN+, AC was not significantly associated with better OS compared to the surveillance group (HR 0.89, 95% CI 0.58-1.35; p = 0.58). Conclusions: The administration of AC in patients with MIBC and pT3-T4 residual disease after NAC might have a positive impact on OS and DSS. However, this may not apply to N+ patients.
Filiaciones:
Krajewski, W:
Wroclaw Med Univ, Dept Urol & Oncol Urol, PL-50556 Wroclaw, Poland
Nowak, L:
Wroclaw Med Univ, Dept Urol & Oncol Urol, PL-50556 Wroclaw, Poland
Moschini, M:
Luzerner Kantonsspital, Klin Urol, CH-6004 Luzern, Switzerland
Poletajew, S:
Ctr Postgrad Med Educ, Dept Urol 2, PL-01813 Warsaw, Poland
Chorbinska, J:
Wroclaw Med Univ, Dept Urol & Oncol Urol, PL-50556 Wroclaw, Poland
Necchi, A:
Fdn IRCCS Ist Nazl Tumori, Dept Med Oncol, I-20133 Milan, Italy
Montorsi, F:
IRCCS Osped San Raffaele, Urol Res Inst URI, Unit Urol, I-20132 Milan, Italy
Briganti, A:
IRCCS Osped San Raffaele, Urol Res Inst URI, Unit Urol, I-20132 Milan, Italy
Sanchez-Salas, R:
Univ Paris 05, Inst Mutualiste Montsouris, Dept Urol, F-75014 Paris, France
Shariat, SF:
Med Univ Vienna, Dept Urol, A-1090 Vienna, Austria
Univ Texas Southwestern Med Ctr Dallas, Dept Urol, Dallas, TX 75390 USA
Weill Cornell Med Coll, Dept Urol, New York, NY 10065 USA
LM Sechenov First Moscow State Med Univ, Inst Urol & Reprod Hlth, Moscow 119146, Russia
Univ Jordan, Jordan Univ Hosp, Div Urol, Dept Special Surg, Amman 11942, Jordan
European Assoc Urol Res Fdn, NL-6803 AA Arnhem, Netherlands
Charles Univ Prague, Fac Med 2, Dept Urol, Prague 15006, Czech Republic
Charles Univ Prague, Hosp Motol, Prague 15006, Czech Republic
Palou, J:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona 08025, Spain
Babjuk, M:
Charles Univ Prague, Fac Med 2, Dept Urol, Prague 15006, Czech Republic
Charles Univ Prague, Hosp Motol, Prague 15006, Czech Republic
Teoh, JY:
Chinese Univ Hong Kong, Prince Wales Hosp, Dept Surg, SH Ho Urol Ctr, Hong Kong, Peoples R China
Soria, F:
Univ Studies Torino, San Giovanni Battista Hosp, Div Urol, Dept Surg Sci, I-10124 Turin, Italy
Pradere, B:
Med Univ Vienna, Dept Urol, A-1090 Vienna, Austria
Univ Hosp Tours, Dept Oncol & Urol, F-37000 Tours, France
Ornaghi, PI:
Luzerner Kantonsspital, Klin Urol, CH-6004 Luzern, Switzerland
Pawlak, A:
Wroclaw Univ Environm & Life Sci, Dept Pharmacol & Toxicol, Fac Vet Med, PL-50375 Wroclaw, Poland
Dembowski, J:
Wroclaw Med Univ, Dept Urol & Oncol Urol, PL-50556 Wroclaw, Poland
Zdrojowy, R:
Wroclaw Med Univ, Dept Urol & Oncol Urol, PL-50556 Wroclaw, Poland
gold, Green Published
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