Original Research ARTICLE
NEOADJUVANT VERSUS ADJUVANT CHEMOTHERAPY IN MUSCLE INVASIVE BLADDER CANCER (MIBC): ANALYSIS FROM THE RISC DATABASE
- 1Azienda Ospedaliera San Camillo-Forlanini, Italy
- 2Istituto Nazionale del Cancro Regina Elena, Italy
- 3Fox Chase Cancer Center, United States
- 4Dana–Farber Cancer Institute, United States
- 5Fred Hutchinson Cancer Research Center, United States
- 6University of Southampton, United Kingdom
- 7City of Hope National Medical Center, United States
- 8University of Michigan, United States
- 9St Bartholomew's Hospital, United Kingdom
- 10Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRCCS), Italy
- 11Huntsman Cancer Institute, University of Utah, United States
- 12National and Kapodistrian University of Athens, Greece
- 13Centre Georges François Leclerc, France
- 14Istituto Nazionale dei Tumori (IRCCS), Italy
- 15Barbara Ann Karmanos Cancer Institute, United States
- 16Heinrich Heine Universität Düsseldorf, Germany
- 17Rabin Medical Center, Israel
- 18Icahn School of Medicine at Mount Sinai, United States
Background: MIBC is an aggressive disease, with 5-year survival rates ranging from 36% to 48% for p T3/p T4/p N+tumors. Perioperative treatment can improve overall survival, with more robust evidence in favor of neoadjuvant chemotherapy. Few randomized studies have compared neoadjuvant and adjuvant therapy in bladder cancer. Consequently, it has been difficult to establish the benefit of adjuvant chemotherapy(AC) in MIBC.
Methods:Data from patients with muscle invasive bladder cancer (>pT2) collected from 2005 to 2012 within the RISC data base (Retrospective International Study of Cancers of the Urothelial Tract) were evaluated. Overall survival(OS), cancer specific survival (CSS) and disease-free survival (DFS) between NC and AC generated using the Kaplan-Meier methodwere compared for MIBC by log-rank test. All patients in this analysis received either NC or AC.
Results: A total of 656 patients with MIBC (325 treated with AC and 331 with NC) were analyzed. The median disease-free survival (DFS) was 37.6 months (95% CI:24.7-50.5) for NC vs 24.3 months (95% CI: 19.3- 29.3) with AC, with a reduction in the risk of disease progression of 21% in favor of NC (HR: 0.79, 95% CI: 0.63-0.99, p: 0.04). There were no significant differences in terms of CSS (HR: 1.21, IC 95%: 0.90-1.63, p: 0.21), and OS (HR: 1.22, 95% CI: 0.95-1.58, P=0.12).
Conclusions: Within the limits of this retrospective study, this analysis suggests that NC is the best treatment for MIBC in terms of DFS. Nonetheless, CSS and OS were similar with both NC and AC strategies.
Keywords: muscle invasive bladder cancer, Neoadjuvant chemotherapy, Adjuvant chemotherapy, RISC data base, Locally advanced bladder cancer
Received: 06 Aug 2018;
Accepted: 02 Oct 2018.
Edited by:Fabio Grizzi, Humanitas Research Hospital, Italy
Reviewed by:Naokazu Ibuki, Osaka Medical College, Japan
Hiroaki Matsumoto, Yamaguchi University, Japan
Mohamed S. Zaghloul, National Cancer Institute, Cairo University, Egypt
Copyright: © 2018 Del Bene, Calabro', Giannarelli, Plimack, Harshman, Yu, Crabb, Pal, Alva, Powles, De Giorgi, Agarwal, Bamias, Ladoire, Necchi, Vaishampayan, Niegisch, Bellmunt, Baniel, Galsky and Sternberg. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dr. Cora N. Sternberg, Azienda Ospedaliera San Camillo-Forlanini, Rome, Lazio, Italy, email@example.com