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Neoadjuvant vs. adjuvant chemotherapy in Muscle Invasive Bladder Cancer (MIBC): analysis from the RISC database

Neoadjuvant vs. adjuvant chemotherapy in Muscle Invasive Bladder Cancer (MIBC): analysis from the RISC database
Neoadjuvant vs. adjuvant chemotherapy in Muscle Invasive Bladder Cancer (MIBC): analysis from the RISC database
Background: MIBC is an aggressive disease, with 5-year survival rates ranging from 36% to 48% for p T3/p T4/p N+tumors. Perioperative treatment can improve overall survival, with more robust evidence in favor of neoadjuvant chemotherapy. Few randomized studies have compared neoadjuvant and adjuvant therapy in bladder cancer. Consequently, it has been difficult to establish the benefit of adjuvant chemotherapy(AC) in MIBC. 
Methods: data from patients with muscle invasive bladder cancer (>pT2) collected from 2005 to 2012 within the RISC data base (Retrospective International Study of Cancers of the Urothelial Tract) were evaluated. Overall survival(OS), cancer specific survival (CSS) and disease-free survival (DFS) between NC and AC generated using the Kaplan-Meier methodwere compared for MIBC by log-rank test. All patients in this analysis received either NC or AC. Results: A total of 656 patients with MIBC (325 treated with AC and 331 with NC) were analyzed. The median disease-free survival (DFS) was 37.6 months (95% CI:24.7-50.5) for NC vs 24.3 months (95% CI: 19.3- 29.3) with AC, with a reduction in the risk of disease progression of 21% in favor of NC (HR: 0.79, 95% CI: 0.63-0.99, p: 0.04). There were no significant differences in terms of CSS (HR: 1.21, IC 95%: 0.90-1.63, p: 0.21), and OS (HR: 1.22, 95% CI: 0.95-1.58, P=0.12). 
Conclusions: within the limits of this retrospective study, this analysis suggests that NC is the best treatment for MIBC in terms of DFS. Nonetheless, CSS and OS were similar with both NC and AC strategies.
2234-943X
463
Del Bene, Gabriella
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Calabrò, Fabio
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Giannarelli, Diana
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Plimack, Elizabeth R.
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Harshman, Lauren C.
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Yu, Evan Y.
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Crabb, Simon J.
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Pal, Sumanta Kumar
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Alva, Ajjai S.
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Powles, Thomas
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De Giorgi, Ugo
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Agarwal, Neeraj
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Bamias, Aristotelis
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Ladoire, Sylvain
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Necchi, Andrea
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Vaishampayan, Ulka N.
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Niegisch, Günter
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Bellmunt, Joaquim
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Baniel, Jack
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Galsky, Matthew D.
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Sternberg, Cora N.
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Del Bene, Gabriella
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Calabrò, Fabio
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Giannarelli, Diana
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Plimack, Elizabeth R.
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Harshman, Lauren C.
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Yu, Evan Y.
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Crabb, Simon J.
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Pal, Sumanta Kumar
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Alva, Ajjai S.
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Powles, Thomas
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De Giorgi, Ugo
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Agarwal, Neeraj
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Bamias, Aristotelis
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Ladoire, Sylvain
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Necchi, Andrea
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Vaishampayan, Ulka N.
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Niegisch, Günter
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Bellmunt, Joaquim
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Baniel, Jack
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Galsky, Matthew D.
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Sternberg, Cora N.
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Del Bene, Gabriella, Calabrò, Fabio, Giannarelli, Diana, Plimack, Elizabeth R., Harshman, Lauren C., Yu, Evan Y., Crabb, Simon J., Pal, Sumanta Kumar, Alva, Ajjai S., Powles, Thomas, De Giorgi, Ugo, Agarwal, Neeraj, Bamias, Aristotelis, Ladoire, Sylvain, Necchi, Andrea, Vaishampayan, Ulka N., Niegisch, Günter, Bellmunt, Joaquim, Baniel, Jack, Galsky, Matthew D. and Sternberg, Cora N. (2018) Neoadjuvant vs. adjuvant chemotherapy in Muscle Invasive Bladder Cancer (MIBC): analysis from the RISC database. Frontiers in Oncology, 8, 463. (doi:10.3389/fonc.2018.00463).

Record type: Article

Abstract

Background: MIBC is an aggressive disease, with 5-year survival rates ranging from 36% to 48% for p T3/p T4/p N+tumors. Perioperative treatment can improve overall survival, with more robust evidence in favor of neoadjuvant chemotherapy. Few randomized studies have compared neoadjuvant and adjuvant therapy in bladder cancer. Consequently, it has been difficult to establish the benefit of adjuvant chemotherapy(AC) in MIBC. 
Methods: data from patients with muscle invasive bladder cancer (>pT2) collected from 2005 to 2012 within the RISC data base (Retrospective International Study of Cancers of the Urothelial Tract) were evaluated. Overall survival(OS), cancer specific survival (CSS) and disease-free survival (DFS) between NC and AC generated using the Kaplan-Meier methodwere compared for MIBC by log-rank test. All patients in this analysis received either NC or AC. Results: A total of 656 patients with MIBC (325 treated with AC and 331 with NC) were analyzed. The median disease-free survival (DFS) was 37.6 months (95% CI:24.7-50.5) for NC vs 24.3 months (95% CI: 19.3- 29.3) with AC, with a reduction in the risk of disease progression of 21% in favor of NC (HR: 0.79, 95% CI: 0.63-0.99, p: 0.04). There were no significant differences in terms of CSS (HR: 1.21, IC 95%: 0.90-1.63, p: 0.21), and OS (HR: 1.22, 95% CI: 0.95-1.58, P=0.12). 
Conclusions: within the limits of this retrospective study, this analysis suggests that NC is the best treatment for MIBC in terms of DFS. Nonetheless, CSS and OS were similar with both NC and AC strategies.

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Accepted/In Press date: 2 October 2018
e-pub ahead of print date: 19 November 2018
Published date: 19 November 2018

Identifiers

Local EPrints ID: 426846
URI: http://eprints.soton.ac.uk/id/eprint/426846
ISSN: 2234-943X
PURE UUID: 34087719-2d08-497d-a66f-5ab0a7beae5f
ORCID for Simon J. Crabb: ORCID iD orcid.org/0000-0003-3521-9064

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Date deposited: 13 Dec 2018 17:30
Last modified: 16 Mar 2024 03:32

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Contributors

Author: Gabriella Del Bene
Author: Fabio Calabrò
Author: Diana Giannarelli
Author: Elizabeth R. Plimack
Author: Lauren C. Harshman
Author: Evan Y. Yu
Author: Simon J. Crabb ORCID iD
Author: Sumanta Kumar Pal
Author: Ajjai S. Alva
Author: Thomas Powles
Author: Ugo De Giorgi
Author: Neeraj Agarwal
Author: Aristotelis Bamias
Author: Sylvain Ladoire
Author: Andrea Necchi
Author: Ulka N. Vaishampayan
Author: Günter Niegisch
Author: Joaquim Bellmunt
Author: Jack Baniel
Author: Matthew D. Galsky
Author: Cora N. Sternberg

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