Dlouhodobé výsledky neoadjuvantní chemoterapie a radikální cystektomie v léčbě invazivních nádorů močového měchýře

Long ‑term results of neoadjuvant chemotherapy and radical cystectomy  in the treatment of muscle invasive bladder cancer

Aims: Neoadjuvant chemotherapy (NAC) with radical cystectomy (RC) is the recommended treat ment for muscle invasive bladder tumors (MIBC) However, more than half of patients are unable to undergo NAC due to contraindications The aim of the study is to evaluate the long ‑term onco logical results from one tertiary center and thus demonstrate the effectiveness of neoadjuvant chemotherapy in muscle ‑invasive bladder tumors Methods: In the years 2010–2021, 100 patients with MIBC underwent neoadjuvant (for cN0) / in duction (for cN+) chemotherapy –⁠ most often as a combination of cisplatin and gemcitabine Pa tients with cT3–4 or cN+ were indicated for NAC; in the subgroup of cT2N0, the patients were selected according to risk factors Out of a of 100 patients, 49 were without lymphadenopathy (cN0) and 51 with enlarged nodes (cN1–3) Progression occurred in 8 patients during NAC (2× in cN0, 6× in cN+), two patients refused surgical treatment after NAC Subsequent radical cystectomy was performed in 47/49 cN0 and 43/51 cN1–3 patients The study evaluated the intention ‑to ‑treat population, even the patients who did not undergo surgical treat ment were included We assessed five ‑year cancer‑‑specific survival (CSS) using Kaplan ‑Meier curves and compared survival within subgroups using the log ‑rank test Response to chemotherapy was defined as complete (pCR –⁠ ypT0N0), partial (pPR ≤ ypT1N0) or no response (non ‑R; ≥ypT2N0–3) The influence of clinical and histopathological pa rameters on progression ‑free survival (PFS) was evaluated using the Cox regression model Median follow ‑up was 43 months (IQR 16–87) Results: The average age of the patients was 64 years, men and women comprised 76% and 24% of the cohort, respectively The extent of the primary tu mor was cT2 in 39 and cT3–4 in 61 cases The median number of lymph nodes removed during procedure was 24 (IQR 19;29) Five ‑year CSS reached 84% in cT2–4N0 and 52% in cT2–4N1–3 Five ‑year CSS was not different for cN1 versus cN2–3 (53% and 50%, respectively) We recorded a response to chemo therapy (cCR+pCR) in 34/49 (69%) patients with cN0 and in 24/51 (47%) cN1–3 Achieving response to chemotherapy improved 5‑year CSS in both sub groups, in cN0 patients 93% versus 60% (p=0 001), in cN1–3 85% versus 27% (p<0 001) In the entire group, the 30‑day and 90‑day mortality reached 0% and 3%, respectively In multivariate analysis, significant predictors of progression ‑free survival were initial nodal involvement (HR 2 92; p=0 007) and failure to respond to NAC (HR 6 56; p≤0 001) Conclusion: In patients with invasive bladder cancer who are treated with neoadjuvant chemo therapy followed by radical cystectomy, excellent oncological results can be achieved in clinically localized disease Even in the case of clinical lym phadenopathy, up to half of patients survive five years Achieving a response to chemotherapy and the absence of lymphadenopathy at the time of diagnosis reduce the risk of recurrence

Keywords:

Chemotherapy, neoadjuvant therapy, urinary bladder neoplasms