Outcome after radical cystectomy in patients with clinical T2 bladder cancer in whom neoadjuvant chemotherapy has failed

Murugesan Manoharan, Devendar Katkoori, Thekke A. Kishore, Bruce Kava, Rakesh Singal, Mark S Soloway

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Objective To analyse the outcome after radical cystectomy (RC) in patients with clinical T2 bladder cancer not responding to neoadjuvant chemotherapy (NAC). Patients and 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 (≥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). CONCLUSION A lack of response to NAC is associated with a significantly higher local and distant recurrence, and with lower survival.

Original languageEnglish (US)
Pages (from-to)1646-1649
Number of pages4
JournalBJU International
Volume104
Issue number11
DOIs
StatePublished - Dec 1 2009

Keywords

  • Bladder cancer
  • Clinical T2
  • Neoadjuvant chemotherapy
  • Radical cystectomy
  • Response

ASJC Scopus subject areas

  • Urology

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