Impact of Adjuvant Chemotherapy on Survival of Patients with Advanced Residual Disease at Radical Cystectomy following Neoadjuvant Chemotherapy : Systematic Review and Meta-Analysis
Krajewski, Wojciech (Wrocław Medical University (Wroclaw, Polònia))
Nowak, Łukasz (Wrocław Medical University (Wroclaw, Polònia))
Moschini, Marco (Luzerner Kantonsspital, Lucerne, Switzerland)
Poletajew, Sławomir (Centre of Postgraduate Medical Education, Warsaw, Poland)
Chorbińska, Joanna (Wrocław Medical University (Wroclaw, Polònia))
Necchi, Andrea (Fondazione IRCCS Ospedale San Raffaele (Milà, Itàlia))
Montorsi, Francesco (IRCCS Ospedale San Raffaele (Milà, Itàlia))
Briganti, Alberto (IRCCS Ospedale San Raffaele (Milà, Itàlia))
Sanchez-Salas, Rafael (Université Paris-Descartes, Paris, France)
Shariat, Shahrokh F. (Charles University, Prague, Czech Republic)
Palou, Juan
Babjuk, Marek (Institut d'Investigació Biomèdica Sant Pau)
Teoh, Jeremy Y. C. (The Chinese University of Hong Kong, Hong Kong)
Soria, Francesco (San Giovanni Battista Hospital)
Pradere, Benjamin (University Hospital of Tours, Tours)
Ornaghi, Paola Irene (Luzerner Kantonsspital, Lucerne, Switzerland)
Pawlak, Aleksandra (Wroclaw University of Environmental and Life Sciences, Wrocław, Poland)
Dembowski, Janusz (Wrocław Medical University (Wroclaw, Polònia))
Zdrojowy, Romuald (Wrocław Medical University (Wroclaw, Polònia))
Universitat Autònoma de Barcelona

Date:	2021
Abstract:	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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article de revisió ; recerca ; Versió publicada
Subject:	Adjuvant chemotherapy ; Muscle-invasive bladder cancer ; Neoadjuvant chemotherapy
Published in:	Journal of clinical medicine, Vol. 10 (february 2021) , ISSN 2077-0383

DOI: 10.3390/jcm10040651
PMID: 33567656

11 p, 2.5 MB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles