Neoadjuvant Versus Adjuvant Chemotherapy in Non-Metastatic Locally-Advanced Stage Radical Cystectomy Candidates

• Published in: Clinical genitourinary cancer Vol. 22; no. 5; p. 102132
• Main Authors: de Angelis, Mario, Siech, Carolin, Jannello, Letizia Maria Ippolita, Bello, Francesco Di, Peñaranda, Natali Rodriguez, Goyal, Jordan A., Touma, Nawar, Tian, Zhe, Longo, Nicola, de Cobelli, Ottavio, Chun, Felix K.H., Micali, Salvatore, Saad, Fred, Shariat, Shahrokh F., Gandaglia, Giorgio, Moschini, Marco, Montorsi, Francesco, Briganti, Alberto, Karakiewicz, Pierre I.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2024
• Subjects: Adjuvant chemotherapy; Bladder cancer; Locally-advanced; Neoadjuvant chemotherapy; Urothelial carcinoma; Neoadjuvant chemotherapy; Adjuvant chemotherapy; Locally-advanced; Urothelial carcinoma; Bladder cancer
• ISSN: 1558-7673; 1938-0682; 1938-0682
• DOI: 10.1016/j.clgc.2024.102132

Administration of chemotherapy before radical cystectomy (RC) in neoadjuvant setting (NAC) or after RC in adjuvant setting (ADJ) are both associated with a survival benefit relative to RC alone. However, no study directly compared the magnitude of such benefit associated with NAC versus ADJ in locally-advanced UCUB patients (T3-T4N0M0). We addressed this knowledge gap. Within the Surveillance, Epidemiology, and End Results database (2007–2020), we identified T3-T4N0M0 UCUB patients who underwent NAC+RC or RC+ADJ. Cumulative incidence plots and multivariable competing risks regression (CRR) models were fitted. The same methodology was then re-applied in T3 and then T4 patient subgroups. Of 875 assessable patients, 603 harbored T3 stage (69.0%) and 272 harbored T4 stage (31.0%). Of all 875, 563 (64.0%) underwent RC+ADJ versus 312 (36.0%) NAC+RC. NAC+RC rates increased over time (EAPC=+6.1%, P = .001). Cumulative incidence plots derived five-year CSM rates were 40.3% in NAC+RC versus 36.1% in RC+ADJ patients (P = .2). In multivariable CRR models that also adjusted for OCM, no statistically significant difference in CSM was recorded when NAC+RC was compared to RC+ADJ (HR:0.85, P = .1). Virtually the same observations were made in subgroup analyses where CSM associated with NAC+RC was not different from that recorded in RC+ADJ (HR: 0.89 and P = .4 in T3 stage and HR:0.8 and P = .2 in T4 stage). In locally-advanced UCUB, NAC rates have sharply increased over time. However, the approach based on neoadjuvant chemotherapy prior to RC have not resulted in a statistically significant CSM benefit relative to RC+ADJ. No study directly compared neoadjuvant (NAC) versus adjuvant chemotherapy (ADJ) T3-T4N0M0 urothelial carcinoma. Within the Surveillance, Epidemiology, and End Results database (2007–2020), we identified 875 T3-T4N0M0 UCUB patients who underwent NAC+RC or RC+ADJ. Our result suggests that in T3-T4N0M0, NAC rates have sharply increased over time. However, the approach based on NAC+ RC have not resulted in a statistically significant survival benefit relative to RC+ADJ.