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06.07.2023 | Topic Paper

Survival after sequential neoadjuvant chemotherapy followed by trimodal treatment or radical cystectomy for muscle-invasive bladder cancer

verfasst von: Pierre-Louis Reignier, Hélène Gauthier, Christophe Hennequin, Quiterie Aussedat, Evanguelos Xylinas, François Desgrandchamps, Stéphane Culine, Alexandra Masson-Lecomte, Clément Dumont

Erschienen in: World Journal of Urology | Ausgabe 11/2023

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Abstract

Purpose

to assess the respective outcomes of patients with localized muscle-invasive bladder cancer (MIBC) treated by either radical cystectomy (RC) or trimodal treatment (TMT) depending on pathological response to previous neoadjuvant chemotherapy (NAC) assessed on cystectomy specimen or post-NAC transurethral resection (TURB) specimen, respectively.

Patient and methods

We retrospectively included all consecutive patients treated in one academic center with cisplatin-based NAC followed by RC or TMT for cT2-3N0M0 MIBC between 2014 and 2021. Primary endpoint was metastasis-free survival (MFS) in both treatment groups and according to pathological response to NAC. Local recurrence-free survival and conservative management failure (metastasis-free bladder-intact survival) for patients treated with TMT were assessed.

Results

104 patients were included, 26 treated with TMT and 78 with RC. The rate of complete pathological response was 47.4% in patients treated with RC (ypT0) and 66.7% in patients treated with TMT (ycT0). Median follow-up was 34.9 months. Four-year MFS was 72% in both treatment groups. Four-year MFS was 85% in both ypT0 RC patients and ycT0 TMT patients. ycT0 stage was associated with low rates of intravesical recurrence and conservative management failure.

Conclusion

Patients with post-NAC ycT0 stage treated with TMT have favorable oncological outcomes similar to those of ypT0 patients treated with RC. Assessment of complete histological response with TURB after NAC may help in selecting the best candidates for bladder preservation with TMT.

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Titel: Survival after sequential neoadjuvant chemotherapy followed by trimodal treatment or radical cystectomy for muscle-invasive bladder cancer
verfasst von: Pierre-Louis Reignier
Hélène Gauthier
Christophe Hennequin
Quiterie Aussedat
Evanguelos Xylinas
François Desgrandchamps
Stéphane Culine
Alexandra Masson-Lecomte
Clément Dumont
Publikationsdatum: 06.07.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 11/2023
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-023-04506-9

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Survival after sequential neoadjuvant chemotherapy followed by trimodal treatment or radical cystectomy for muscle-invasive bladder cancer