دورية أكاديمية
Assessing risk of lymph node invasion in complete responders to neoadjuvant chemotherapy for muscle-invasive bladder cancer.
| العنوان: | Assessing risk of lymph node invasion in complete responders to neoadjuvant chemotherapy for muscle-invasive bladder cancer. |
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| المؤلفون: | Flammia RS; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy.; Department of Surgery, Sapienza University of Rome, Rome, Italy., Tuderti G; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy., Bologna E; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy.; Department of Surgery, Sapienza University of Rome, Rome, Italy., Minore A; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy., Proietti F; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy.; Department of Surgery, Sapienza University of Rome, Rome, Italy., Licari LC; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy., Mastroianni R; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy., Anceschi U; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy., Brassetti A; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy., Bove A; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy., Misuraca L; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy., D'Annunzio S; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy., Ferriero MC; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy., Guaglianone S; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy., Chiacchio G; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy., De Nunzio C; Department of Surgery, Sapienza University of Rome, Rome, Italy.; Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy., Leonardo C; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy., Simone G; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy. |
| المصدر: | BJU international [BJU Int] 2024 Jun 24. Date of Electronic Publication: 2024 Jun 24. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Blackwell Science Country of Publication: England NLM ID: 100886721 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1464-410X (Electronic) Linking ISSN: 14644096 NLM ISO Abbreviation: BJU Int Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Oxford, UK : Blackwell Science, c1999- |
| مستخلص: | Objectives: To investigate the lymph node invasion (LNI) rate in patients exhibiting complete pathological response (CR) to neoadjuvant chemotherapy (NAC) and to test the association of CR status with lower LNI and better survival outcomes. Materials and Methods: We included patients with bladder cancer (BCa; cT2-4a; cN0; cM0) treated with NAC and radical cystectomy (RC) + pelvic lymph node dissection (PLND) at our institution between 2012 and 2022 (N = 157). CR (ypT0) and LNI (ypN+) were defined at final pathology. Univariable and multivariable logistic regression analysis was performed to test the association between CR and LNI after adjusting for number of lymph nodes removed (NLR). Kaplan-Meier and Cox regression analyses were used to assess overall survival (OS), metastasis-free survival (MFS) and disease free-survival (DFS) according to CR status. Results: Overall CR and LNI rates were 40.1% and 19%, respectively. The median (interquartile range [IQR]) NLR was 26 (19-36). The LNI rate was lower in patients with CR vs those without CR (2 [3.2%] vs 61 [29.8%]; P < 0.001). After adjusting for NLR, CR reduced the LNI risk by 93% (odds ratio 0.07, 95% confidence interval [CI] 0.01-0.25; P < 0.001). Kaplan-Meier plots depicted better 5-year OS (69.7 vs 52.2%), MFS (68.3 vs 45.5%) and DFS (66.6 vs 43.5%) in patients with CR vs those without CR. After multivariable adjustments, CR independently reduced the risk of death (hazard ratio [HR] 0.44, 95% CI 0.24-0.81; P = 0.008), metastatic progression (HR 0.41, 95% CI 0.23-0.71; P = 0.002) and disease progression (HR 0.41, 95% CI 0.24-0.70; P = 0.001). Conclusion: Based on these findings, we postulate that PLND could potentially be omitted in patients exhibiting CR after NAC, due to negligible risk of LNI. Prospective Phase II trials are needed to explore this challenging hypothesis. (© 2024 The Author(s). BJU International published by John Wiley & Sons Ltd on behalf of BJU International.) |
| References: | Leow JJ, Fay AP, Mullane SA, Bellmunt J. Perioperative therapy for muscle invasive bladder cancer. Hematol Oncol Clin North Am 2015; 29: 301–318. Grossman HB, Natale RB, Tangen CM et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 2003; 349: 859–866. Geynisman DM, Abbosh P, Ross EA et al. A phase II trial of risk‐enabled therapy after initiating neoadjuvant chemotherapy for bladder cancer (RETAIN). JCO 2023; 41(6_suppl): 438. Galsky MD, Daneshmand S, Izadmehr S et al. Gemcitabine and cisplatin plus nivolumab as organ‐sparing treatment for muscle‐invasive bladder cancer: a phase 2 trial. Nat Med 2023; 29: 2825–2834. Alfred Witjes J, Max Bruins H, Carrión A et al. European Association of Urology guidelines on muscle‐invasive and metastatic bladder cancer: summary of the 2023 guidelines. Eur Urol 2024; 85: 17–31. Mastroianni R, Tuderti G, Ferriero M et al. Robot‐assisted radical cystectomy with totally Intracorporeal urinary diversion versus open radical cystectomy: 3‐year outcomes from a randomised controlled trial. Eur Urol 2024; 85: 422–430. Catto JWF, Khetrapal P, Ricciardi F et al. Effect of robot‐assisted radical cystectomy with Intracorporeal urinary diversion vs open radical cystectomy on 90‐day morbidity and mortality among patients with bladder cancer: a randomized clinical trial. JAMA 2022; 327: 2092–2103. Gschwend JE, Heck MM, Lehmann J et al. Extended versus limited lymph node dissection in bladder cancer patients undergoing radical cystectomy: survival results from a prospective. Randomized Trial Eur Urol 2019; 75: 604–611. Lerner SP, Tangen C, Svatek RS et al. SWOG S1011: a phase III surgical trial to evaluate the benefit of a standard versus an extended lymphadenectomy performed at time of radical cystectomy for muscle invasive urothelial cancer. JCO 2023; 41(16_suppl): 4508. Perera M, McGrath S, Sengupta S, Crozier J, Bolton D, Lawrentschuk N. Pelvic lymph node dissection during radical cystectomy for muscle‐invasive bladder cancer. Nat Rev Urol 2018; 15: 686–692. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–383. Clavien PA, Barkun J, De Oliveira ML et al. The Clavien‐Dindo classification of surgical complications: five‐year experience. Ann Surg 2009; 250: 187–196. Edge SB, Compton CC. The American joint committee on cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010; 17: 1471–1474. Capitanio U, Suardi N, Shariat SF et al. Assessing the minimum number of lymph nodes needed at radical cystectomy in patients with bladder cancer. BJU Int 2009; 103: 1359–1362. Clinckaert A, Callens K, Cooreman A et al. The prevalence of lower limb and genital lymphedema after prostate cancer treatment: a systematic review. Cancer 2022; 14: 5667. Nassiri N, Ghodoussipour S, Maas M et al. Occult nodal metastases in patients down‐staged to nonmuscle invasive disease following neoadjuvant chemotherapy. Urology 2020; 142: 155–160. Van Hoogstraten LMC, Van Gennep EJ, Kiemeney LALM et al. Occult lymph node metastases in patients without residual muscle‐invasive bladder cancer at radical cystectomy with or without neoadjuvant chemotherapy: a nationwide study of 5417 patients. World J Urol 2022; 40: 111–118. Pfister C, Gravis G, Fléchon A et al. Randomized phase III trial of dose‐dense methotrexate, vinblastine, doxorubicin, and cisplatin, or gemcitabine and cisplatin as perioperative chemotherapy for patients with muscle‐invasive bladder cancer. Analysis of the GETUG/AFU V05 VESPER trial secondary endpoints: chemotherapy toxicity and pathological responses. Eur Urol 2021; 79: 214–221. Kaczmarek K, Małkiewicz B, Lemiński A. Adequate pelvic lymph node dissection in radical cystectomy in the era of neoadjuvant chemotherapy: a meta‐analysis and systematic review. Cancer 2023; 15: 4040. Strandgaard T, Nordentoft I, Birkenkamp‐Demtröder K et al. Field cancerization is associated with tumor development, T‐cell exhaustion, and clinical outcomes in bladder cancer. Eur Urol 2024; 85: 82–92. Kukreja JB, Porten S, Golla V et al. Absence of tumor on repeat transurethral resection of bladder tumor does not predict final pathologic T0 stage in bladder cancer treated with radical cystectomy. Eur Urol Focus 2018; 4: 720–724. Soubra A, Gencturk M, Froelich J et al. FDG‐PET/CT for assessing the response to neoadjuvant chemotherapy in bladder cancer patients. Clin Genitourin Cancer 2018; 16: 360–364. Necchi A, Bandini M, Calareso G et al. Multiparametric magnetic resonance imaging as a noninvasive assessment of tumor response to neoadjuvant pembrolizumab in muscle‐invasive bladder cancer: preliminary findings from the PURE‐01 study. Eur Urol 2020; 77: 636–643. Leonardo C, Flammia RS, Lucciola S et al. Performance of node‐RADS scoring system for a standardized assessment of regional lymph nodes in bladder cancer patients. Cancer 2023; 15: 580. Pecoraro M, Del Giudice F, Magliocca F et al. Vesical imaging‐reporting and data system (VI‐RADS) for assessment of response to systemic therapy for bladder cancer: preliminary report. Abdom Radiol 2022; 47: 763–770. Lu YT, Plets M, Morrison G et al. Cell‐free DNA methylation as a predictive biomarker of response to neoadjuvant chemotherapy for patients with muscle‐invasive bladder cancer in SWOG S1314. Eur Urol Oncol 2023; 6: 516–524. Plimack ER, Dunbrack RL, Brennan TA et al. Defects in DNA repair genes predict response to neoadjuvant cisplatin‐based chemotherapy in muscle‐invasive bladder cancer. Eur Urol 2015; 68: 959–967. Beckabir W, Wobker SE, Damrauer JS et al. Spatial relationships in the tumor microenvironment demonstrate association with pathologic response to neoadjuvant chemoimmunotherapy in muscle‐invasive bladder cancer. Eur Urol 2024; 85: 242–253. Mi H, Bivalacqua TJ, Kates M et al. Predictive models of response to neoadjuvant chemotherapy in muscle‐invasive bladder cancer using nuclear morphology and tissue architecture. Cell Rep Med 2021; 2: 100382. Choi SJ, Park KJ, Heo C, Park BW, Kim M, Kim JK. Radiomics‐based model for predicting pathological complete response to neoadjuvant chemotherapy in muscle‐invasive bladder cancer. Clin Radiol 2021; 76: 627.e13–21. |
| فهرسة مساهمة: | Keywords: complete response; muscle‐invasive bladder cancer; neoadjuvant chemotherapy; pelvic lymph node dissection; radical cystectomy |
| تواريخ الأحداث: | Date Created: 20240626 Latest Revision: 20240626 |
| رمز التحديث: | 20240627 |
| DOI: | 10.1111/bju.16440 |
| PMID: | 38923233 |
| قاعدة البيانات: | MEDLINE |
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