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Impact of neoadjuvant chemotherapy on short-term complications and survival following radical cystectomy

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World Journal of Urology Aims and scope Submit manuscript

Abstract

Objectives

To compare perioperative and short-term postoperative complication rates between patients receiving radical cystectomy (RC) after neoadjuvant chemotherapy (NAC) and patients undergoing RC alone. Secondary objectives were to compare overall survival (OS) and cancer-specific survival (CSS).

Materials and methods

Clinico-pathological data of all patients who received RC between 1996 and 2015 were retrospectively collected. Only patients with RC for muscle-invasive bladder cancer were included in the final analysis. Short-term (30-day) postoperative complications were assessed by registering the Clavien–Dindo classification (CDC) and dividing into sub-groups: low-grade (LGC) CDC 1–2 and high-grade (HGC) CDC 3–5. To compare populations with similar age, comorbidities and preoperative creatinine, we used a propensity score-adjusted statistical model. Pre- and perioperative predictors of short-term complications were identified using uni- and multivariable models. Survival was assessed using Kaplan–Meier analysis.

Results

A total of 491 patients undergoing RC were included, of whom 102 (20.8%) received NAC. After propensity score covariate adjustment, there was no significant difference in postoperative complications between patients undergoing NAC plus RC and RC alone with an overall complication rate of 69% and 66%, respectively. No significant differences in the 30-day HGC rates (11.76% and 11.83%, respectively) were observed. NAC plus RC patients had worse prognostic factors at baseline; nevertheless, after correction for group differences OS and CSS did not differ from RC only group (5-year OS 61.3% vs. 50.2%, and 5-year CSS 61.8% vs. 57.9% respectively, p > 0.05 for all).

Conclusion

In appropriately selected patients, exposure to NAC is not associated with increased short-term complications.

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Abbreviations

BC:

Bladder cancer

NMIBC:

Non-muscle-invasive bladder cancer

MIBC:

Muscle-invasive bladder cancer

RC:

Radical cystectomy

PLND:

Pelvic lymph node dissection

UD:

Urinary diversion

NAC:

Neoadjuvant chemotherapy

OS:

Overall survival

BCG:

Bacillus Calmette–Guérin

CIS:

Carcinoma in situ

CCI:

Charlson comorbidity index

ACCI:

Age-adjusted Charlson comorbidity index

BMI:

Body mass index

TNM:

Tumor-node-metastasis

EBL:

Estimated blood loss

LoS:

Length of stay

CDC:

Clavien–Dindo Classification

HGC:

High-grade complication

LGC:

Low-grade complication

CSS:

Cancer-specific survival

SD:

Standard deviation

IQR:

Interquartile range

CIF:

Cumulative incidence function

IPTW:

Inverse probability of treatment weighting

OR:

Odds ratio

CI:

Confidence interval

HR:

Hazard ratio

OCS:

Other-cause survival

UTI:

Urinary tract infection

MVAC:

Methotrexate–Vinblastine–Adriamycin–Cisplatin

GC:

Gemcitabine–Cisplatin

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Acknowledgments

Akand M is supported by a clinical scholarship from the European Urologic Scholarship Program (EUSP).Joniau S is a senior clinical researcher of the research foundation of Flanders (FWO).

Funding

None declared.

Author information

Authors and Affiliations

  1. Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium

    Uros Milenkovic, Murat Akand, Lisa Moris, Liesbeth Demaegd, Tim Muilwijk, Youri Bekhuis, Annouschka Laenen, Ben Van Cleynenbreugel, Wouter Everaerts, Hein Van Poppel, Maarten Albersen & Steven Joniau

  2. Laboratory of Experimental Urology, Department of Development and Regeneration, Catholic University of Leuven, Louvain, Belgium

    Uros Milenkovic, Wouter Everaerts & Maarten Albersen

  3. School of Medicine, Department of Urology, Selcuk University, Konya, Turkey

    Murat Akand

  4. University Hospitals Leuven, Department of General Medical Oncology, Leuven Cancer Institute, KU Leuven, Louvain, Belgium

    Herlinde Dumez

Authors
  1. Uros Milenkovic
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  2. Murat Akand
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Contributions

UM: Data collection, data analysis, manuscript writing. MA: Data analysis, manuscript writing, manuscript editing. LM: Data collection, data analysis. LD: Data collection, data analysis. TM: Data analysis, manuscript editing. YB: Data collection, data analysis. AL: Data analysis, manuscript editing. BVC: Data collection, data analysis. WE: Data collection, data analysis. HVP: Project development, data analysis, manuscript editing. HD: Project development, data analysis, manuscript editing. MA: Project development, data analysis, manuscript editing. SJ: Project development, data analysis, manuscript editing.

Corresponding author

Correspondence to Steven Joniau.

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The authors declare that they have no conflict of interest related to this manuscript.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Milenkovic, U., Akand, M., Moris, L. et al. Impact of neoadjuvant chemotherapy on short-term complications and survival following radical cystectomy. World J Urol 37, 1857–1866 (2019). https://doi.org/10.1007/s00345-018-2584-0

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  • DOI: https://doi.org/10.1007/s00345-018-2584-0

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