Concomitant CIS on TURBT does not impact oncological outcomes in patients treated with neoadjuvant or induction chemotherapy followed by radical cystectomy

N. Vasdev, H. Zargar, J. P. Noël, R. Veeratterapillay, A. S. Fairey, L. S. Mertens, C. P. Dinney, M. C. Mir, L. M. Krabbe, M. S. Cookson, N. E. Jacobsen, N. M. Gandhi, J. Griffin, J. S. Montgomery, E. Y. Yu, E. Xylinas, N. J. Campain, W. Kassouf, M. A. Dall’Era, J. A. SeahC. E. Ercole, S. Horenblas, S. S. Sridhar, J. S. McGrath, J. Aning, S. F. Shariat, J. L. Wright, T. M. Morgan, T. J. Bivalacqua, S. North, D. A. Barocas, Yair Lotan, P. Grivas, A. J. Stephenson, J. B. Shah, B. W. van Rhijn, S. Daneshmand, P. E. Spiess, J. M. Holzbeierlein, A. Thorpe, P. C. Black

Research output: Contribution to journalArticle

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Abstract

Background: Cisplatin-based neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer improves all-cause and cancer specific survival. We aimed to evaluate whether the detection of carcinoma in situ (CIS) at the time of initial transurethral resection of bladder tumor (TURBT) has an oncological impact on the response to NAC prior to radical cystectomy. Patients and methods: Patients were identified retrospectively from 19 centers who received at least three cycles of NAC or induction chemotherapy for cT2-T4aN0-3M0 urothelial carcinoma of the bladder followed by radical cystectomy between 2000 and 2013. The primary and secondary outcomes were pathological response and overall survival, respectively. Multivariable analysis was performed to determine the independent predictive value of CIS on these outcomes. Results: Of 1213 patients included in the analysis, 21.8% had concomitant CIS. Baseline clinical and pathologic characteristics of the ‘CIS’ versus ‘no-CIS’ groups were similar. The pathological response did not differ between the two arms when response was defined as pT0N0 (17.9% with CIS vs 21.9% without CIS; p = 0.16) which may indicate that patients with CIS may be less sensitive to NAC or ≤ pT1N0 (42.8% with CIS vs 37.8% without CIS; p = 0.15). On Cox regression model for overall survival for the cN0 cohort, the presence of CIS was not associated with survival (HR 0.86 (95% CI 0.63–1.18; p = 0.35). The presence of LVI (HR 1.41, 95% CI 1.01–1.96; p = 0.04), hydronephrosis (HR 1.63, 95% CI 1.23–2.16; p = 0.001) and use of chemotherapy other than ddMVAC (HR 0.57, 95% CI 0.34–0.94; p = 0.03) were associated with shorter overall survival. For the whole cohort, the presence of CIS was also not associated with survival (HR 1.05 (95% CI 0.82–1.35; p = 0.70). Conclusion: In this multicenter, real-world cohort, CIS status at TURBT did not affect pathologic response to neoadjuvant or induction chemotherapy. This study is limited by its retrospective nature as well as variability in chemotherapy regimens and surveillance regimens.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalWorld Journal of Urology
DOIs
StateAccepted/In press - Jun 7 2018

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Induction Chemotherapy
Cystectomy
Carcinoma in Situ
Urinary Bladder Neoplasms
Drug Therapy
Survival
Hydronephrosis
Proportional Hazards Models
Cisplatin
Urinary Bladder

Keywords

  • Bladder cancer
  • Carcinoma insitu
  • Neoadjuvant chemotherapy
  • Radical cystectomy

ASJC Scopus subject areas

  • Urology

Cite this

Concomitant CIS on TURBT does not impact oncological outcomes in patients treated with neoadjuvant or induction chemotherapy followed by radical cystectomy. / Vasdev, N.; Zargar, H.; Noël, J. P.; Veeratterapillay, R.; Fairey, A. S.; Mertens, L. S.; Dinney, C. P.; Mir, M. C.; Krabbe, L. M.; Cookson, M. S.; Jacobsen, N. E.; Gandhi, N. M.; Griffin, J.; Montgomery, J. S.; Yu, E. Y.; Xylinas, E.; Campain, N. J.; Kassouf, W.; Dall’Era, M. A.; Seah, J. A.; Ercole, C. E.; Horenblas, S.; Sridhar, S. S.; McGrath, J. S.; Aning, J.; Shariat, S. F.; Wright, J. L.; Morgan, T. M.; Bivalacqua, T. J.; North, S.; Barocas, D. A.; Lotan, Yair; Grivas, P.; Stephenson, A. J.; Shah, J. B.; van Rhijn, B. W.; Daneshmand, S.; Spiess, P. E.; Holzbeierlein, J. M.; Thorpe, A.; Black, P. C.

In: World Journal of Urology, 07.06.2018, p. 1-8.

Research output: Contribution to journalArticle

Vasdev, N, Zargar, H, Noël, JP, Veeratterapillay, R, Fairey, AS, Mertens, LS, Dinney, CP, Mir, MC, Krabbe, LM, Cookson, MS, Jacobsen, NE, Gandhi, NM, Griffin, J, Montgomery, JS, Yu, EY, Xylinas, E, Campain, NJ, Kassouf, W, Dall’Era, MA, Seah, JA, Ercole, CE, Horenblas, S, Sridhar, SS, McGrath, JS, Aning, J, Shariat, SF, Wright, JL, Morgan, TM, Bivalacqua, TJ, North, S, Barocas, DA, Lotan, Y, Grivas, P, Stephenson, AJ, Shah, JB, van Rhijn, BW, Daneshmand, S, Spiess, PE, Holzbeierlein, JM, Thorpe, A & Black, PC 2018, 'Concomitant CIS on TURBT does not impact oncological outcomes in patients treated with neoadjuvant or induction chemotherapy followed by radical cystectomy', World Journal of Urology, pp. 1-8. https://doi.org/10.1007/s00345-018-2361-0
Vasdev, N. ; Zargar, H. ; Noël, J. P. ; Veeratterapillay, R. ; Fairey, A. S. ; Mertens, L. S. ; Dinney, C. P. ; Mir, M. C. ; Krabbe, L. M. ; Cookson, M. S. ; Jacobsen, N. E. ; Gandhi, N. M. ; Griffin, J. ; Montgomery, J. S. ; Yu, E. Y. ; Xylinas, E. ; Campain, N. J. ; Kassouf, W. ; Dall’Era, M. A. ; Seah, J. A. ; Ercole, C. E. ; Horenblas, S. ; Sridhar, S. S. ; McGrath, J. S. ; Aning, J. ; Shariat, S. F. ; Wright, J. L. ; Morgan, T. M. ; Bivalacqua, T. J. ; North, S. ; Barocas, D. A. ; Lotan, Yair ; Grivas, P. ; Stephenson, A. J. ; Shah, J. B. ; van Rhijn, B. W. ; Daneshmand, S. ; Spiess, P. E. ; Holzbeierlein, J. M. ; Thorpe, A. ; Black, P. C. / Concomitant CIS on TURBT does not impact oncological outcomes in patients treated with neoadjuvant or induction chemotherapy followed by radical cystectomy. In: World Journal of Urology. 2018 ; pp. 1-8.
@article{8d0cc156b32b40bbb67aa84e797349f3,
title = "Concomitant CIS on TURBT does not impact oncological outcomes in patients treated with neoadjuvant or induction chemotherapy followed by radical cystectomy",
abstract = "Background: Cisplatin-based neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer improves all-cause and cancer specific survival. We aimed to evaluate whether the detection of carcinoma in situ (CIS) at the time of initial transurethral resection of bladder tumor (TURBT) has an oncological impact on the response to NAC prior to radical cystectomy. Patients and methods: Patients were identified retrospectively from 19 centers who received at least three cycles of NAC or induction chemotherapy for cT2-T4aN0-3M0 urothelial carcinoma of the bladder followed by radical cystectomy between 2000 and 2013. The primary and secondary outcomes were pathological response and overall survival, respectively. Multivariable analysis was performed to determine the independent predictive value of CIS on these outcomes. Results: Of 1213 patients included in the analysis, 21.8{\%} had concomitant CIS. Baseline clinical and pathologic characteristics of the ‘CIS’ versus ‘no-CIS’ groups were similar. The pathological response did not differ between the two arms when response was defined as pT0N0 (17.9{\%} with CIS vs 21.9{\%} without CIS; p = 0.16) which may indicate that patients with CIS may be less sensitive to NAC or ≤ pT1N0 (42.8{\%} with CIS vs 37.8{\%} without CIS; p = 0.15). On Cox regression model for overall survival for the cN0 cohort, the presence of CIS was not associated with survival (HR 0.86 (95{\%} CI 0.63–1.18; p = 0.35). The presence of LVI (HR 1.41, 95{\%} CI 1.01–1.96; p = 0.04), hydronephrosis (HR 1.63, 95{\%} CI 1.23–2.16; p = 0.001) and use of chemotherapy other than ddMVAC (HR 0.57, 95{\%} CI 0.34–0.94; p = 0.03) were associated with shorter overall survival. For the whole cohort, the presence of CIS was also not associated with survival (HR 1.05 (95{\%} CI 0.82–1.35; p = 0.70). Conclusion: In this multicenter, real-world cohort, CIS status at TURBT did not affect pathologic response to neoadjuvant or induction chemotherapy. This study is limited by its retrospective nature as well as variability in chemotherapy regimens and surveillance regimens.",
keywords = "Bladder cancer, Carcinoma insitu, Neoadjuvant chemotherapy, Radical cystectomy",
author = "N. Vasdev and H. Zargar and No{\"e}l, {J. P.} and R. Veeratterapillay and Fairey, {A. S.} and Mertens, {L. S.} and Dinney, {C. P.} and Mir, {M. C.} and Krabbe, {L. M.} and Cookson, {M. S.} and Jacobsen, {N. E.} and Gandhi, {N. M.} and J. Griffin and Montgomery, {J. S.} and Yu, {E. Y.} and E. Xylinas and Campain, {N. J.} and W. Kassouf and Dall’Era, {M. A.} and Seah, {J. A.} and Ercole, {C. E.} and S. Horenblas and Sridhar, {S. S.} and McGrath, {J. S.} and J. Aning and Shariat, {S. F.} and Wright, {J. L.} and Morgan, {T. M.} and Bivalacqua, {T. J.} and S. North and Barocas, {D. A.} and Yair Lotan and P. Grivas and Stephenson, {A. J.} and Shah, {J. B.} and {van Rhijn}, {B. W.} and S. Daneshmand and Spiess, {P. E.} and Holzbeierlein, {J. M.} and A. Thorpe and Black, {P. C.}",
year = "2018",
month = "6",
day = "7",
doi = "10.1007/s00345-018-2361-0",
language = "English (US)",
pages = "1--8",
journal = "World Journal of Urology",
issn = "0724-4983",
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TY - JOUR

T1 - Concomitant CIS on TURBT does not impact oncological outcomes in patients treated with neoadjuvant or induction chemotherapy followed by radical cystectomy

AU - Vasdev, N.

AU - Zargar, H.

AU - Noël, J. P.

AU - Veeratterapillay, R.

AU - Fairey, A. S.

AU - Mertens, L. S.

AU - Dinney, C. P.

AU - Mir, M. C.

AU - Krabbe, L. M.

AU - Cookson, M. S.

AU - Jacobsen, N. E.

AU - Gandhi, N. M.

AU - Griffin, J.

AU - Montgomery, J. S.

AU - Yu, E. Y.

AU - Xylinas, E.

AU - Campain, N. J.

AU - Kassouf, W.

AU - Dall’Era, M. A.

AU - Seah, J. A.

AU - Ercole, C. E.

AU - Horenblas, S.

AU - Sridhar, S. S.

AU - McGrath, J. S.

AU - Aning, J.

AU - Shariat, S. F.

AU - Wright, J. L.

AU - Morgan, T. M.

AU - Bivalacqua, T. J.

AU - North, S.

AU - Barocas, D. A.

AU - Lotan, Yair

AU - Grivas, P.

AU - Stephenson, A. J.

AU - Shah, J. B.

AU - van Rhijn, B. W.

AU - Daneshmand, S.

AU - Spiess, P. E.

AU - Holzbeierlein, J. M.

AU - Thorpe, A.

AU - Black, P. C.

PY - 2018/6/7

Y1 - 2018/6/7

N2 - Background: Cisplatin-based neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer improves all-cause and cancer specific survival. We aimed to evaluate whether the detection of carcinoma in situ (CIS) at the time of initial transurethral resection of bladder tumor (TURBT) has an oncological impact on the response to NAC prior to radical cystectomy. Patients and methods: Patients were identified retrospectively from 19 centers who received at least three cycles of NAC or induction chemotherapy for cT2-T4aN0-3M0 urothelial carcinoma of the bladder followed by radical cystectomy between 2000 and 2013. The primary and secondary outcomes were pathological response and overall survival, respectively. Multivariable analysis was performed to determine the independent predictive value of CIS on these outcomes. Results: Of 1213 patients included in the analysis, 21.8% had concomitant CIS. Baseline clinical and pathologic characteristics of the ‘CIS’ versus ‘no-CIS’ groups were similar. The pathological response did not differ between the two arms when response was defined as pT0N0 (17.9% with CIS vs 21.9% without CIS; p = 0.16) which may indicate that patients with CIS may be less sensitive to NAC or ≤ pT1N0 (42.8% with CIS vs 37.8% without CIS; p = 0.15). On Cox regression model for overall survival for the cN0 cohort, the presence of CIS was not associated with survival (HR 0.86 (95% CI 0.63–1.18; p = 0.35). The presence of LVI (HR 1.41, 95% CI 1.01–1.96; p = 0.04), hydronephrosis (HR 1.63, 95% CI 1.23–2.16; p = 0.001) and use of chemotherapy other than ddMVAC (HR 0.57, 95% CI 0.34–0.94; p = 0.03) were associated with shorter overall survival. For the whole cohort, the presence of CIS was also not associated with survival (HR 1.05 (95% CI 0.82–1.35; p = 0.70). Conclusion: In this multicenter, real-world cohort, CIS status at TURBT did not affect pathologic response to neoadjuvant or induction chemotherapy. This study is limited by its retrospective nature as well as variability in chemotherapy regimens and surveillance regimens.

AB - Background: Cisplatin-based neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer improves all-cause and cancer specific survival. We aimed to evaluate whether the detection of carcinoma in situ (CIS) at the time of initial transurethral resection of bladder tumor (TURBT) has an oncological impact on the response to NAC prior to radical cystectomy. Patients and methods: Patients were identified retrospectively from 19 centers who received at least three cycles of NAC or induction chemotherapy for cT2-T4aN0-3M0 urothelial carcinoma of the bladder followed by radical cystectomy between 2000 and 2013. The primary and secondary outcomes were pathological response and overall survival, respectively. Multivariable analysis was performed to determine the independent predictive value of CIS on these outcomes. Results: Of 1213 patients included in the analysis, 21.8% had concomitant CIS. Baseline clinical and pathologic characteristics of the ‘CIS’ versus ‘no-CIS’ groups were similar. The pathological response did not differ between the two arms when response was defined as pT0N0 (17.9% with CIS vs 21.9% without CIS; p = 0.16) which may indicate that patients with CIS may be less sensitive to NAC or ≤ pT1N0 (42.8% with CIS vs 37.8% without CIS; p = 0.15). On Cox regression model for overall survival for the cN0 cohort, the presence of CIS was not associated with survival (HR 0.86 (95% CI 0.63–1.18; p = 0.35). The presence of LVI (HR 1.41, 95% CI 1.01–1.96; p = 0.04), hydronephrosis (HR 1.63, 95% CI 1.23–2.16; p = 0.001) and use of chemotherapy other than ddMVAC (HR 0.57, 95% CI 0.34–0.94; p = 0.03) were associated with shorter overall survival. For the whole cohort, the presence of CIS was also not associated with survival (HR 1.05 (95% CI 0.82–1.35; p = 0.70). Conclusion: In this multicenter, real-world cohort, CIS status at TURBT did not affect pathologic response to neoadjuvant or induction chemotherapy. This study is limited by its retrospective nature as well as variability in chemotherapy regimens and surveillance regimens.

KW - Bladder cancer

KW - Carcinoma insitu

KW - Neoadjuvant chemotherapy

KW - Radical cystectomy

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DO - 10.1007/s00345-018-2361-0

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JO - World Journal of Urology

JF - World Journal of Urology

SN - 0724-4983

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