Selecting the Best Candidates for Cisplatin-based Adjuvant Chemotherapy After Radical Cystectomy Among Patients with pN+ Bladder Cancer.

Abstract

A trend towards greater benefit from adjuvant chemotherapy (ACT) in pN+ bladder cancer (BCa) has been observed in multiple randomized controlled trials. However, it is still unclear which patients might benefit the most from this approach. We retrospectively analyzed a multicenter cohort of 1381 patients with pTany pN1-3 cM0 R0 urothelial BCa treated with radical cystectomy (RC) with or without cisplatin-based ACT. The main endpoint was overall survival (OS) after RC. We performed 1:1 propensity score matching to adjust for baseline characteristics and conducted a classification and regression tree (CART) analysis to assess postoperative risk groups and Cox regression analyses to predict OS. Overall, 391 patients (28%) received cisplatin-based ACT. After matching, two cohorts of 281 patients with pN+ BCa were obtained. CART analysis stratified patients into three risk groups: favorable prognosis (≤pT2 and positive lymph node [PLN] count ≤2; odds ratio [OR] 0.43), intermediate prognosis (≥pT3 and PLN count ≤2; OR 0.92), and poor prognosis (pTany and PLN count ≥3; OR 1.36). Only patients with poor prognosis benefitted from ACT in terms of OS (HR 0.51; p < 0.001). We created the first algorithm that stratifies patients with pN+ BCa into prognostic classes and identified patients with pTany BCa with PLN ≥3 as the most suitable candidates for cisplatin-based ACT. PATIENT SUMMARY: We found that overall survival among patients with bladder cancer and evidence of lymph node involvement depends on cancer stage and the number of positive lymph nodes. Patients with more than three nodes affected by metastases seem to experience the greatest overall survival benefit from cisplatin-based chemotherapy after bladder removal. Our study suggests that patients with the highest risk should be prioritized for cisplatin-based chemotherapy after bladder removal.

• Authors: Luca Afferi, Chiara Lonati, Francesco Montorsi, Alberto Briganti, Andrea Necchi, Andrea Mari, Andrea Minervini, Riccardo Tellini, Riccardo Campi, Gerald Bastian Schulz, Peter C Black, Ettore di Trapani, Ottavio de Cobelli, R Jeffrey Karnes, Mohamed Ahmed, M Carmen Mir, Maria Asuncion Algarra, Michael Rink, Stefania Zamboni, Francesca Mondini, Claudio Simeone, Alessandro Antonelli, Alessandro Tafuri, Wojciech Krajewski, Bartosz Małkiewicz, Evanguelos Xylinas, Francesco Soria, Rafael Sanchez Salas, Amandeep Arora, Xavier Cathelineau, Kees Hendricksen, Maida Ammiwala, Marco Borghesi, Francesco Chierigo, Jeremy Yuen-Chun Teoh, Agostino Mattei, Simone Albisinni, Florian Roghmann, Mathieu Roumiguié, Anne Sophie Bajeot, Elisabeth Maier, Atiqullah Aziz, Rodolfo Hurle, Roberto Contieri, Benjamin Pradere, Roberto Carando, Cedric Poyet, Mario Alvarez-Maestro, David D'Andrea, Shahrokh F Shariat, Marco Moschini, European Association of Urology Young Academic Urologists Urothelial Carcinoma Working Group
• Journal: European urology oncology (Eur Urol Oncol) Vol. 5 Issue 6 Pg. 722-725 (12 2022) ISSN: 2588-9311 [Electronic] Netherlands
• PMID: 35715319 (Publication Type: Multicenter Study, Journal Article)
• Copyright: Copyright © 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Chemical References

• Cisplatin

Topics

• Humans
• Cystectomy (adverse effects)
• Cisplatin (therapeutic use)
• Urinary Bladder (pathology)
• Retrospective Studies
• Treatment Outcome
• Urinary Bladder Neoplasms (drug therapy, surgery, pathology)
• Chemotherapy, Adjuvant