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Effect of optimal neoadjuvant chemotherapy on oncological outcomes of locally advanced bladder cancer with laparoscopic radical cystectomy: A matched‐pair analysis in a multicenter cohort
Author(s) -
Kubota Masashi,
Kanno Toru,
Inoue Takahiro,
Yamasaki Toshinari,
Okumura Kazuhiro,
Ito Katsuhiro,
Yamada Hitoshi,
Fujii Masato,
Shimizu Yosuke,
Yatsuda Junji,
Moroi Seiji,
Shichiri Yasumasa,
Akao Toshiya,
Sawada Atsuro,
Saito Ryoich,
Kobayashi Takashi,
Kawakita Mutsushi,
Ogawa Osamu
Publication year - 2021
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.14533
Subject(s) - medicine , cystectomy , bladder cancer , cohort , propensity score matching , chemotherapy , retrospective cohort study , regimen , urology , oncology , incidence (geometry) , neoadjuvant therapy , surgery , cancer , breast cancer , physics , optics
Objectives To assess the effect of optimal neoadjuvant chemotherapy of at least three cycles of cisplatin‐based regimen on oncological outcomes of clinical stage T3 or higher bladder cancer treated with laparoscopic radical cystectomy. Methods Laparoscopic radical cystectomies carried out at 10 institutions were included in this retrospective study. The outcomes of patients who received optimal neoadjuvant chemotherapy and those who did not receive neoadjuvant chemotherapy were compared using propensity score matching in clinical stage T3–4 or T2 cohorts, separately. Results Of the 455 patients screened, matched pairs of 54 patients in the clinical T3–4 cohort and 68 patients in the clinical T2 cohort were finally analyzed. In the cT3–4 cohort, the 5‐year overall survival (78% vs 41%; P = 0.014), cancer‐specific survival (81% vs 44%; P = 0.008) and recurrence‐free survival (71% vs 53%; P = 0.049) were significantly higher in the optimal neoadjuvant chemotherapy group than in the no neoadjuvant chemotherapy group; no significant survival difference was shown between the two groups in the cT2 cohort. In the cT3–4 cohort, the incidence of local recurrence (4% vs 26%; P = 0.025) and abdominal or intrapelvic recurrence, including peritoneal carcinomatosis (7% vs 30%; P = 0.038), was significantly lower in the optimal neoadjuvant chemotherapy group. Conclusions Administration of optimal neoadjuvant chemotherapy has a significant survival benefit. It decreases the incidence of local and atypical recurrence patterns in patients with clinical stage T3 or higher locally advanced bladder cancer undergoing laparoscopic radical cystectomy.