Chemotherapy increases survival and downstaging of upper tract urothelial cancer.
Chemotherapy increases survival and downstaging of upper tract urothelial cancer. Can J Urol. 2019 Oct;26(5):9938-9944 Authors: Davaro F, May A, McFerrin C, Raza SJ, Siddiqui S, Hamilton Z Abstract INTRODUCTION: To evaluate the overall survival and pathologic downstaging effect of neoadjuvant chemotherapy for upper tract urothelial cell carcinoma. MATERIALS AND METHODS: The National Cancer Database (NCDB) was queried for patients with stage II-IV upper tract urothelial cell carcinoma undergoing definitive surgical resection (nephroureterectomy) from 2004-2015. Patients with metastatic disease were excluded. Cohorts were stratified by receipt of neoadjuvant chemotherapy (NAC). Kaplan-Meier analysis and Cox regression were used to evaluate overall survival. Logistic regression was used to predict the odds of pathologic downstaging to non-invasive disease (
Conclusion: Neoadjuvant chemotherapy utilization continues to slowly increase in patients with MIBC. Patients with variant histology lag behind in terms of receiving NAC but appear to derive as much benefit as patients with pure urothelial cell bladder cancer.
AbstractBackgroundSquamous cell carcinoma (SCC) of the bladder is a rare, aggressive malignancy. Unlike urothelial cell carcinoma, SCC is resistant to chemotherapy and guidelines recommend radical cystectomy (RC) without neoadjuvant chemotherapy (NAC). We aimed to evaluate the current management and survival of patients with invasive SCC treated with or without NAC.Methods671 patients with invasive SCC bladder cancer from 2004 to 2015 in the National Cancer Data Base were identified. Patients were stratified by treatment with RC alone or NAC prior to RC (NAC + RC). Survival analysis was performed with Kaplan...
Dr. Daniel Goldstein reviews highlights in bladder cancer from ASCO 2018, including important studies evaluating the efficacy of neoadjuvant immunotherapy instead of chemotherapy for muscle-invasive t... Author: BeaconMedIC Added: 07/27/2018
Use of neoadjuvant cisplatin-based chemotherapy (NAC) in UTUC is based on evidence of survival benefit in urothelial carcinoma (UC) of the bladder. However, concerns regarding toxicity and lack of efficacy have prevented its widespread adoption. We aim to analyze the genomic profiling data of UTUCs from patients who received NAC to identify predictors of chemo-sensitivity.
Pathological response following neoadjuvant chemotherapy (NAC) has been shown to be an excellent surrogate for survival in bladder cancer. In upper tract urothelial cancer (UTUC), unlike bladder, preoperative endoscopic and pathologic assessment of response is difficult. The aim of this study is to determine whether imaging response following NAC predicted the final pathologic stage and outcomes following radical nephroureterectomy (NU).
High-risk upper tract urothelial carcinoma has been associated with poor survival outcomes. Limited retrospective data supports the use of neoadjuvant chemotherapy prior to radical nephroureterectomy. We evaluated the change in pathologic stage distribution in patients with high-risk upper tract urothelial carcinoma who underwent neoadjuvant chemotherapy followed by radical nephroureterectomy to validate prior findings.
Nested variant (NV) urothelial cell carcinoma (UCC) is a rare histological subtype of UCC with benign features. There is limited data on the outcomes and characteristics of patients with this histology (largest study with 52 patients); however, it has traditionally been viewed as a more aggressive subtype of UCC and neoadjuvant chemotherapy is not recommended. Our primary interest was to assess whether there is a difference in overall survival (OS) after radical cystectomy (RC) between patients with NV features compared to patients with pure UCC.
This article reviews several histologic variants and their value in deciding management of cT1 disease and predicting response to neoadjuvant chemotherapy (NAC). Diagnostic issues are also addressed, such as interobserver variability among pathologists. For example, although stage cT1 conventional urothelial carcinoma is usually managed conservatively, cT1 micropapillary carcinoma has high mortality following conservative management, and early cystectomy may reduce mortality. Similarly, plasmacytoid and small cell cancers are remarkably aggressive, and those diagnosed as stage cT1 at transurethral resection are likely unde...
CONCLUSIONS: Platinum-based NAC was associated with similar survival benefit as patients undergoing cystectomy and/or radiotherapy. No conclusion can be drawn about the optimal platinum-based combination to be used in the neoadjuvant setting. PMID: 28447581 [PubMed - in process]
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 64-year-old man with a history of cigarette smoking but no significant comorbidities presented with hem...