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Optimal pathological response after neoadjuvant chemotherapy for muscle-invasive bladder cancer: results from a global, multicentre collaboration

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Abstract
Objectives To evaluate outcomes of patients achieving a post-treatment pathological stage of
Patients and Methods Patients from 10 international centres who underwent NAC for cT2-4aN0-1 MIBC and achieved
Results A total of 625 patients were included. The median age was 66 years and 80% were male. Gemcitabine and cisplatin (GC, 56%) and methotrexate, vinblastine, doxorubicin and cisplatin (MVAC)/dose-dense (dd)MVAC (32%) were the most common NAC regimens. ypT0, pure ypTis, ypTa +/- ypTis and ypT1 +/- ypTis were attained in 58.1%, 20.0%, 7.6% and 14.2% of patients, respectively. The cumulative incidence of recurrence at 5 years was 9%, 16%, 29% and 30%, respectively. Pathological stage was prognostic for recurrence, with ypTa +/- Tis (hazard ratio [HR] 3.20, 95% confidence interval [CI] 1.40-7.30) and ypT1 +/- Tis disease (HR 4.03, 95% CI 2.13-7.63) associated with a significantly higher recurrence risk. Pure ypTis (HR 1.66, 95% CI 0.82-3.38) and the type of NAC regimen (ddMVAC: HR 1.59, 95% CI 0.55-4.56; MVAC: HR 1.18, 9%% CI 0.25-5.54; reference: GC) were not associated with recurrence.

Conclusion We propose that optimal pathological response after NAC be defined as attainment of ypT0N0/ypTisN0 at RC. Patients with ypTaN0 or ypT1N0 disease (with or without Tis) at RC displayed a significantly higher risk of recurrence and may be candidates for trials investigating adjuvant therapy.
Author(s)
이재련Ajjai AlvaAndrea GallinaAndrea NecchiBradley A McGregorCamilla M GrunewaldCatherine CurranChristopher SuGregory R PondGuenter NiegischGuru P SonpavdeJonathan D TwardKathleen M OlsonLeonidas N DiamantopoulosMarco BandiniMatthew MossanenParminder SinghPetros GrivasPraful RaviR
Issued Date
2021
Type
Article
Keyword
#BladderCancer#blcsmbladder cancerneoadjuvant chemotherapypathological responserecurrence.
DOI
10.1111/bju.15434
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8464
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2519805181&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Optimal%20pathological%20response%20after%20neoadjuvant%20chemotherapy%20for%20muscle-invasive%20bladder%20cancer:%20results%20from%20a%20global,%20multicentre%20collaboration&offset=0&pcAvailability=true
Publisher
BJU INTERNATIONAL
Location
미국
Language
한국어
ISSN
1464-4096
Citation Volume
128
Citation Number
5
Citation Start Page
607
Citation End Page
614
Appears in Collections:
Medicine > Medicine
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