Impact of Adjuvant Chemotherapy on Survival of Patients with Advanced Residual Disease at Radical Cystectomy following Neoadjuvant Chemotherapy: Systematic Review and Meta-Analysis
Wojciech Krajewski , Łukasz Nowak , Marco Moschini , Sławomir Poletajew , Joanna Chorbińska , Andrea Necchi , Francesco Montorsi , Alberto Briganti , Rafael Sanchez-Salas , Shahrokh F. Shariat , Juan Palou , Marek Babjuk , Jeremy YC Teoh , Francesco Soria , Benjamin Pradere , Paola Irene Ornaghi , Aleksandra Pawlak , Janusz Dembowski , Romuald Zdrojowy
AbstractBackground: Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) with pelvic lymph-node dissection is the standard treatment for cT2-4a cN0 cM0 muscle-invasive bladder cancer (MIBC). Despite the significant improvement of primary-tumor downstaging with NAC, up to 50% of patients are eventually found to have advanced residual disease (pT3–T4 and/or histopathologically confirmed nodal metastases (pN+)) at RC. Currently, there is no established standard of care in such cases. The aim of this systematic review and meta-analysis was to assess differences in survival rates between patients with pT3–T4 and/or pN+ MIBC who received NAC and surgery followed by adjuvant chemotherapy (AC), and patients without AC. Materials and Methods: A systematic search was conducted in accordance with the PRISMA statement using the Medline, Embase, and Cochrane Library databases. The last search was performed on 12 November 2020. The primary end point was overall survival (OS) and the secondary end point was disease-specific survival (DSS). Results: We identified 2124 articles, of which 6 were selected for qualitative and quantitative analyses. Of a total of 3096 participants in the included articles, 2355 (76.1%) were in the surveillance group and 741 (23.9%) received AC. The use of AC was associated with significantly better OS (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.75–0.94; p = 0.002) and DSS (HR 0.56, 95% CI 0.32–0.99; p = 0.05). Contrary to the main analysis, in the subgroup analysis including only patients with pN+, AC was not significantly associated with better OS compared to the surveillance group (HR 0.89, 95% CI 0.58–1.35; p = 0.58). Conclusions: The administration of AC in patients with MIBC and pT3–T4 residual disease after NAC might have a positive impact on OS and DSS. However, this may not apply to N+ patients.
|Journal series||Journal of Clinical Medicine, ISSN 2077-0383, (N/A 140 pkt)|
|Publication size in sheets||0.5|
|Keywords in English||adjuvant chemotherapy; muscle-invasive bladder cancer; neoadjuvant chemotherapy|
|License||Journal (articles only); published final; ; with publication|
|Score||= 140.0, 28-04-2021, ArticleFromJournal|
|Publication indicators||= 0; : 2018 = 5.688 (2)|
* presented citation count is obtained through Internet information analysis and it is close to the number calculated by the Publish or Perish system.