Outcome after radical cystectomy in patients with clinical T2 bladder cancer in whom neoadjuvant chemotherapy has failed.
OBJECTIVE
To analyse the outcome after radical cystectomy (RC) in patients with clinical T2 bladder cancer not responding to neoadjuvant chemotherapy (NAC).


METHODS
In a retrospective analysis, study patients received NAC for clinical T2 disease before RC and a control group had RC for clinical T2 disease with no NAC. Patients treated with NAC were further grouped based on the pathological response; failure to respond was defined as 'no change in T stage or a higher T stage in the RC specimen (>or=pT2)', and the relevant clinical and pathological data were analysed.


RESULTS
In all, 53 patients satisfied the inclusion criteria for the study group and 200 for the control group. In the study group 18 (34%) responded to NAC (group 1) of whom 11 (61%) were pT0 and seven (39%) pT1, and among the non-responders (group 2) 19 (54%) were pT3/pT4 and 16 (46%) were pT2; 16 (46%) patients in group 2 had lymph node metastasis. The mean follow-up was 26 months. In group 2, local recurrence occurred in six (17%) vs none in group 1. Seven patients (20%) in group 2 developed metastases, vs one (5%) in group 1 (P = 0.01). The 5-year disease-free survival was significantly lower for group 2 (40%) than group 1 (91%, P = 0.007) and the control group (67%, P = 0.04). There were 14 deaths from bladder cancer in group 2, vs one in group I (P = 0.01). The 5-year disease-specific survival was significantly lower for group 2 (52%) than group 1 (83%, P = 0.008) and the control group (70%, P = 0.001).


CONCLUSIONS
A lack of response to NAC is associated with a significantly higher local and distant recurrence, and with lower survival.
Manoharan
Murugesan
M
Departments of Urology and Medicine, Miller School of Medicine, University of Miami, Miami, FL 33101, USA. mmanoharan@med.miami.edu
Katkoori
Devendar
D
Kishore
Thekke A
TA
Kava
Bruce
B
Singal
Rakesh
R
Soloway
Mark S
MS
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015653:Cystectomy / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*