Real-world data on utilization of neoadjuvant chemotherapy for muscle invasive bladder cancer: impact on surgical complications and oncological efficacy
Background and purpose: Recommended treatment of urothelial muscle-invasive bladder cancer (MIBC) is cisplatin-based neoadjuvant chemotherapy (NAC) followed by cystectomy, but there are challenges with low utilization of NAC. We aimed to evaluate the utilization of NAC, perioperative complications a...
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Medical Journals Sweden
2025-01-01
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| Series: | Acta Oncologica |
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| Online Access: | https://medicaljournalssweden.se/actaoncologica/article/view/42052 |
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| author | Hege S. Haugnes Hakon Kjaeve Eivind Bjerkaas Ragnhild Hellesnes Line Hjelle Magnus Larsen |
| author_facet | Hege S. Haugnes Hakon Kjaeve Eivind Bjerkaas Ragnhild Hellesnes Line Hjelle Magnus Larsen |
| author_sort | Hege S. Haugnes |
| collection | DOAJ |
| description | Background and purpose: Recommended treatment of urothelial muscle-invasive bladder cancer (MIBC) is cisplatin-based neoadjuvant chemotherapy (NAC) followed by cystectomy, but there are challenges with low utilization of NAC. We aimed to evaluate the utilization of NAC, perioperative complications and oncological efficacy in a real-world setting.
Patients and methods: All patients operated with radical cystectomy at the University Hospital of North Norway during 2011–2021 for MIBC were included. NAC consisted of three cycles of dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (ddMVAC) every second week. Complications after cystectomy (Clavien-Dindo ≥ grade 3 within 30 days), histopathologic NAC response, cancer recurrence, relapse-free survival (RFS), overall survival (OS) and cause of death were reported.
Results: We included 124 patients, median observation time of 4 years. Fifty-nine patients (48%) received NAC. Most common causes for not receiving NAC were age ≥ 75 years (n = 38; 31%), cardiovascular disease (n = 7; 5.6%), and reduced kidney function (n = 6; 4.8%). Overall 34 patients (27%) had a ≥ grade 3 complication. The 5-year actuarial OS rate was higher among patients treated with NAC than those without NAC (67% vs. 45%, p = 0.02). Among NAC-treated patients, 29 (49%) were downstaged to non-muscle invasive stage (≤pT1), and the 5-year actuarial RFS and OS were higher among patients with ≤pT1 in the post-cystectomy specimen than those with ≥ pT2 (92% vs. 35%, and 94% vs. 39%, both p < 0.001).
Interpretation: The utilization of NAC was high in this real-world setting. Treatment with ddMVAC with achieved downstaging to ≤pT1 was associated with considerably improved RFS and OS.
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| format | Article |
| id | doaj-art-34aef76e80e24ebc857b0e48b9d66eaa |
| institution | Kabale University |
| issn | 1651-226X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Medical Journals Sweden |
| record_format | Article |
| series | Acta Oncologica |
| spelling | doaj-art-34aef76e80e24ebc857b0e48b9d66eaa2025-01-03T07:53:07ZengMedical Journals SwedenActa Oncologica1651-226X2025-01-016410.2340/1651-226X.2025.42052Real-world data on utilization of neoadjuvant chemotherapy for muscle invasive bladder cancer: impact on surgical complications and oncological efficacyHege S. Haugnes0https://orcid.org/0000-0002-9813-0561Hakon Kjaeve1Eivind Bjerkaas2Ragnhild Hellesnes3Line Hjelle4Magnus Larsen5Institute of Clinical Medicine, UIT- The Arctic University, Tromsø, Norway; Department of Oncology, University Hospital of North Norway, Tromsø, NorwayGeneral Practice, Storsteinnes, NorwayUroNord, Urology in North Norway, Tromsø, NorwayInstitute of Clinical Medicine, UIT- The Arctic University, Tromsø, Norway; Department of Oncology, University Hospital of North Norway, Tromsø, NorwayInstitute of Clinical Medicine, UIT- The Arctic University, Tromsø, Norway; Department of Oncology, University Hospital of North Norway, Tromsø, NorwayInstitute of Clinical Medicine, UIT- The Arctic University, Tromsø, Norway; Department of Urology, University Hospital of North Norway, Tromsø, NorwayBackground and purpose: Recommended treatment of urothelial muscle-invasive bladder cancer (MIBC) is cisplatin-based neoadjuvant chemotherapy (NAC) followed by cystectomy, but there are challenges with low utilization of NAC. We aimed to evaluate the utilization of NAC, perioperative complications and oncological efficacy in a real-world setting. Patients and methods: All patients operated with radical cystectomy at the University Hospital of North Norway during 2011–2021 for MIBC were included. NAC consisted of three cycles of dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (ddMVAC) every second week. Complications after cystectomy (Clavien-Dindo ≥ grade 3 within 30 days), histopathologic NAC response, cancer recurrence, relapse-free survival (RFS), overall survival (OS) and cause of death were reported. Results: We included 124 patients, median observation time of 4 years. Fifty-nine patients (48%) received NAC. Most common causes for not receiving NAC were age ≥ 75 years (n = 38; 31%), cardiovascular disease (n = 7; 5.6%), and reduced kidney function (n = 6; 4.8%). Overall 34 patients (27%) had a ≥ grade 3 complication. The 5-year actuarial OS rate was higher among patients treated with NAC than those without NAC (67% vs. 45%, p = 0.02). Among NAC-treated patients, 29 (49%) were downstaged to non-muscle invasive stage (≤pT1), and the 5-year actuarial RFS and OS were higher among patients with ≤pT1 in the post-cystectomy specimen than those with ≥ pT2 (92% vs. 35%, and 94% vs. 39%, both p < 0.001). Interpretation: The utilization of NAC was high in this real-world setting. Treatment with ddMVAC with achieved downstaging to ≤pT1 was associated with considerably improved RFS and OS. https://medicaljournalssweden.se/actaoncologica/article/view/42052neoadjuvant chemotherapycisplatincystectomybladder cancermuscle-invasiveutilization |
| spellingShingle | Hege S. Haugnes Hakon Kjaeve Eivind Bjerkaas Ragnhild Hellesnes Line Hjelle Magnus Larsen Real-world data on utilization of neoadjuvant chemotherapy for muscle invasive bladder cancer: impact on surgical complications and oncological efficacy Acta Oncologica neoadjuvant chemotherapy cisplatin cystectomy bladder cancer muscle-invasive utilization |
| title | Real-world data on utilization of neoadjuvant chemotherapy for muscle invasive bladder cancer: impact on surgical complications and oncological efficacy |
| title_full | Real-world data on utilization of neoadjuvant chemotherapy for muscle invasive bladder cancer: impact on surgical complications and oncological efficacy |
| title_fullStr | Real-world data on utilization of neoadjuvant chemotherapy for muscle invasive bladder cancer: impact on surgical complications and oncological efficacy |
| title_full_unstemmed | Real-world data on utilization of neoadjuvant chemotherapy for muscle invasive bladder cancer: impact on surgical complications and oncological efficacy |
| title_short | Real-world data on utilization of neoadjuvant chemotherapy for muscle invasive bladder cancer: impact on surgical complications and oncological efficacy |
| title_sort | real world data on utilization of neoadjuvant chemotherapy for muscle invasive bladder cancer impact on surgical complications and oncological efficacy |
| topic | neoadjuvant chemotherapy cisplatin cystectomy bladder cancer muscle-invasive utilization |
| url | https://medicaljournalssweden.se/actaoncologica/article/view/42052 |
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