Author:
Ferro Matteo,de Cobelli Ottavio,Musi Gennaro,Lucarelli Giuseppe,Terracciano Daniela,Pacella Daniela,Muto Tommaso,Porreca Angelo,Busetto Gian Maria,Del Giudice Francesco,Soria Francesco,Gontero Paolo,Cantiello Francesco,Damiano Rocco,Crocerossa Fabio,Farhan Abdal Rahman Abu,Autorino Riccardo,Vartolomei Mihai Dorin,Muto Matteo,Marchioni Michele,Mari Andrea,Scafuri Luca,Minervini Andrea,Longo Nicola,Chiancone Francesco,Perdona Sisto,De Placido Pietro,Verde Antonio,Catellani Michele,Luzzago Stefano,Mistretta Francesco Alessandro,Ditonno Pasquale,Caputo Vincenzo Francesco,Battaglia Michele,Zamboni Stefania,Antonelli Alessandro,Greco Francesco,Russo Giorgio Ivan,Hurle Rodolfo,Crisan Nicolae,Manfredi Matteo,Porpiglia Francesco,Di Lorenzo Giuseppe,Crocetto Felice,Buonerba Carlo
Abstract
BackgroundThree or four cycles of cisplatin-based chemotherapy is the standard neoadjuvant treatment prior to cystectomy in patients with muscle-invasive bladder cancer. Although NCCN guidelines recommend 4 cycles of cisplatin-gemcitabine, three cycles are also commonly administered in clinical practice. In this multicenter retrospective study, we assessed a large and homogenous cohort of patients with urothelial bladder cancer (UBC) treated with three or four cycles of neoadjuvant cisplatin-gemcitabine followed by radical cystectomy, in order to explore whether three vs. four cycles were associated with different outcomes.MethodsPatients with histologically confirmed muscle-invasive UBC included in this retrospective study had to be treated with either 3 (cohort A) or 4 (cohort B) cycles of cisplatin-gemcitabine as neoadjuvant therapy before undergoing radical cystectomy with lymphadenectomy. Outcomes including pathologic downstaging to non-muscle invasive disease, pathologic complete response (defined as absence of disease -ypT0), overall- and cancer-specific- survival as well as time to recurrence were compared between cohorts A vs. B.ResultsA total of 219 patients treated at 14 different high-volume Institutions were included in this retrospective study. Patients who received 3 (cohort A) vs. 4 (cohort B) cycles of neoadjuvant cisplatin-gemcitabine were 160 (73,1%) vs. 59 (26,9%).At univariate analysis, the number of neoadjuvant cycles was not associated with either pathologic complete response, pathologic downstaging, time to recurrence, cancer specific, and overall survival. Of note, patients in cohort B vs. A showed a worse non-cancer specific overall survival at univariate analysis (HR= 2.53; 95 CI= 1.05 - 6.10; p=0.046), although this finding was not confirmed at multivariate analysis.ConclusionsOur findings suggest that 3 cycles of cisplatin-gemcitabine may be equally effective, with less long-term toxicity, compared to 4 cycles in the neoadjuvant setting.