AUTHOR=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. , Sternberg Cora N. 

TITLE=Neoadjuvant vs. Adjuvant Chemotherapy in Muscle Invasive Bladder Cancer (MIBC): Analysis From the RISC Database

JOURNAL=Frontiers in Oncology

VOLUME=8

YEAR=2018

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2018.00463

DOI=10.3389/fonc.2018.00463

ISSN=2234-943X

ABSTRACT=<p><bold>Background:</bold> 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.</p><p><bold>Methods:</bold> Data from patients with muscle invasive bladder cancer (&gt;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 method were compared for MIBC by log-rank test. All patients in this analysis received either NC or AC.</p><p><bold>Results:</bold> A total of 656 patients with MIBC (325 treated with AC and 331 with NC) were analyzed. The median DFS was 34.6 months (95% CI:25.3–43.9) for NC vs. 24.9 months (95% CI: 19.4–30.5) with AC, with a reduction in the risk of disease progression of 21% in favor of NC (HR: 0.78, 95% CI: 0.63–0.96, <italic>P</italic> = 0.02). There were no significant differences in terms of CSS (HR: 1.06, 95% CI: 0.79–1.43, <italic>P</italic>: 0.70), and OS (HR: 1.08, 95% CI: 0.83–1.39, <italic>P</italic> = 0.57).</p><p><bold>Conclusions:</bold> This study demonstrates superiority in DFS for NC compared to AC. The positive prognostic impact of complete pathological response to NC was confirmed.</p>