A study on muscle-invasive bladder cancer patients undergoing radical cystectomy found that pre-surgery chemotherapy improved pathologic downstaging rates, particularly in cT2 patients, and additional chemotherapy enhanced overall and recurrence-free survival in those with adverse clinical features.
The following is a summary of “Effectiveness of perioperative chemotherapy and radical cystectomy in treating bladder cancer,” published in the November 2023 issue of Urology by Li, et al.
Even though there is a lot of proof from clinical trials that perioperative chemotherapy works, no real-world study has yet looked at how well it works in treating muscle-invasive bladder cancer (MIBC). Not much was known about the state of the disease before treatment, and real-life factors like a patient having other illnesses that keep them from finishing medication on time affect how well it works. For a study, researchers sought to look at how often perioperative treatment is used, how it affects the rate of clinical downstaging, and the length of time patients who are having a radical cystectomy don’t have a return.
The study looked back at 805 patients with muscle-invasive bladder cancer who had a radical cystectomy without any chemotherapy during the surgery, 761 patients who had chemotherapy before the surgery and then a radical cystectomy, and 134 patients who had a radical cystectomy followed by adjuvant chemotherapy. Important clinicopathologic traits were looked over. They used the Kaplan–Meier method to predict the chances of recurrence-free and overall survival and the Log-rank or Gehan-Breslow tests to compare the results. They looked at how pre-surgery and post-surgery treatment affected the prognosis by figuring out the hazard ratio and 95% CI from a modified Cox proportional hazards model. Two-sided statistical tests were used, and a P-value of less than 0.05 was considered significant. The 5-year RFS was found to be 65.6% for pT0 patients, 59.1% for <pT2 patients, 35.4% for pT2 patients, 15.3% for >pT2 patients, and 10.8% for pN+ patients.
Pathologic downstaging rates rose from 27.5% to 41.1% in people with ≥cT2 BCa before surgery when they received chemotherapy. Based on the clinical T-stage, only cT2 patients had better overall survival (median 62.3 months vs. 41.9 months, P < 0.001) and recurrence-free survival (median 45.3 months vs. 29.0 months, P < 0.01). An extra round of chemotherapy improved overall survival (median OS 32.4 months vs. 16.3 months) and recurrence-free survival (median 22.8 months vs. 10.0 months, P < 0.0001) in people with bad clinical features (≥pT3 or pN+). They talk about the real-life results for a big group of people with muscle-invasive bladder cancer who had surgery with or without chemotherapy before the surgery. Pathologic reaction rates to treatment before surgery were low, and only cT2 patients saw clinical improvement. No matter what stage of pT/N the cancer was in, patients with pathologically advanced MIBC who received adjuvant treatment were more likely to survive.
Source: sciencedirect.com/science/article/abs/pii/S1078143923003320