Journal Article

Predictive value of radiological response rate for pathological response to neoadjuvant chemotherapy and post-cystectomy survival of bladder urothelial cancer

Tomohiro Fukui, Yoshiyuki Matsui, Shigeaki Umeoka, Takahiro Inoue, Tomomi Kamba, Kaori Togashi, Osamu Ogawa and Takashi Kobayashi

in Japanese Journal of Clinical Oncology

Volume 46, issue 6, pages 560-567
Published in print June 2016 | ISSN: 0368-2811
Published online June 2016 | e-ISSN: 1465-3621 | DOI: https://dx.doi.org/10.1093/jjco/hyw025
Predictive value of radiological response rate for pathological response to neoadjuvant chemotherapy and post-cystectomy survival of bladder urothelial cancer

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  • Clinical Medicine
  • Medical Oncology
  • Radiation Oncology
  • Surgical Oncology

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Objective

To determine the predictive value of the radiological response rate assessed by serial pelvic computed tomography scans for pathological response to neoadjuvant chemotherapy and clinical outcomes after radical cystectomy in bladder urothelial cancer patients.

Methods

We retrospectively reviewed 59 patients with muscle-invasive bladder cancer who underwent radical cystectomy following neoadjuvant chemotherapy. Pretreatment and post-neoadjuvant chemotherapy computed tomography scans were evaluated by a single radiologist to determine the radiological response rate based on the largest diameter of the primary tumor. Association of the radiological response rate with pathological findings of the radical cystectomy specimen and post-radical cystectomy clinical outcomes were assessed.

Results

The pathological complete response rate was 25% (n = 15) and the median (range) radiological response rate was 0.58 (0.00–1.00). The radiological response rate was significantly associated with ≤pT1. Patients with pathological downstaging to ≤pTa/is or pT1, compared with those with pT2≤ tumor, had significantly better post-radical cystectomy recurrence-free survival (2-year survival 92.0, 88.9, 36.8%, respectively, P < 0.0001), disease-specific survival (2-year survival 95.8, 88.9, 47.3%, respectively, P < 0.0001) and overall survival (2-year survival 91.7, 88.9, 40.1%, respectively, P < 0.0001). Patients with a higher radiological response rate (≥0.57) had significantly better post-radical cystectomy recurrence-free survival (2-year survival 89.7 vs. 48.1%, P = 0.0011), disease-specific survival (2-year survival 93.2 vs. 48.2%, P < 0.0001) and overall survival (2-year survival 90.0 vs. 39.0%, P < 0.0001). Multivariate analyses using the Cox proportional hazard model revealed that the radiological response rate was an independent predictor for favorable pT stage and recurrence-free survival.

Conclusion

The radiological response rate determined by pretreatment and post-chemotherapy computed tomography scans predicts the pathological outcome and post-radical cystectomy prognosis, which is clinically relevant and useful for patient counselling and decision-making.

Keywords: muscle-invasive bladder cancer; radical cystectomy; CT scan; surrogate marker; survival

Journal Article.  4721 words.  Illustrated.

Subjects: Clinical Medicine ; Medical Oncology ; Radiation Oncology ; Surgical Oncology

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