Impact of Clinical Response to Neoadjuvant Chemotherapy in the Era of Robot Assisted Radical Cystectomy: Results of a Single-Center Experience
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variable | Complete Responders (n = 43) | Partial Responders (n = 15) | No Responders (n = 21) | p |
---|---|---|---|---|
Age (yrs, median, IQR) | 61 (56–66) | 60 (52–67) | 63 (54–66.5) | 0.94 |
Male gender (n, %) | 29 (67.4%) | 9 (60%) | 18 (85.7%) | 0.193 |
Smoker status (n, %) | 18 (41.9%) | 5 (33.3%) | 13 (61.9%) | 0.289 |
Diabetes (n, %) | 2 (4.7%) | 3 (20%) | 3 (14.3%) | 0.117 |
Hypertension (n, %) | 14 (32.6%) | 7 (46.7%) | 9 (42.9%) | 0.293 |
BMI (kg/m2, median, IQR) | 25 (23.5–27.3) | 26 (20–29) | 28.1 ± 5.6 | 0.619 |
ASA score (n, %) | ||||
1–2 | 34 (79.1%) | 13 (86.7%) | 17 (81%) | 0.818 |
3–4 | 9 (20.9%) | 2 (13.3%) | 4(19%) | |
Preoperative Hb (g/dL, median, IQR) | 12.9 (11.5–13.6) | 12.8 (11.8–14) | 13.7 (11.7–14.3) | 0.704 |
Preoperative eGFR (mL/min/1.73m2, median, IQR) | 78.5 (63.5–92) | 64.7 (48.1–77.2) | 85.1 (74.4–98.7) | 0.03 |
Preoperative hydronephrosis (n, %) | ||||
No | 37 (86%) | 11 (73.3%) | 15 (71.4%) | 0.501 |
Left | 1 (2.3%) | 1 (6.7%) | 2 (9.5%) | |
Right | 4 (9.3%) | 1 (6.7%) | 1 (4.8%) | |
Bilateral | 1 (2.3%) | 2 (13.3%) | 3 (14.3%) | |
Preoperative nephrostomy (n, %) | 4 | 3 | 3 | 0.743 |
Baseline CKD (n, %) | ||||
1 | 10(23.3%) | 2 (13.3%) | 9 (42.9%) | 0.05 |
2 | 26 (60.5%) | 9 (60.0%) | 12 (57.1%) | |
3a | 7 (16.3%) | 1 (6.7%) | - | |
3b | - | 2 (13.4%) | - | |
4 | - | 1 (6.6%) | - | |
cT stage (n, %) | ||||
2 | 30 (69.8%) | 9 (60%) | 17 (81%) | 0.651 |
3 | 12 (27.9%) | 6 (40%) | 3 (14.3%) | |
4 | 1 (2.3%) | - | 1 (4.8%) | |
Type of urinary diversion (n, %) | ||||
Padua Ileal neobladder | 37 (86%) | 11 (73.3%) | 16 (76.2%) | 0.729 |
Indiana Pouch | 1 (2.3%) | 2 (13.3%) | 1 (4.8%) | |
Ileal conduit | 5 (11.6%) | 2 (13.3%) | 4 (19%) | |
Median duration from completion of NACT to RARC (days, n, IQR) | 35 (31–39) | 34 (30–37) | 37 (32–40) | 0.654 |
Variable | Complete Responders (n = 43) | Partial Responders (n = 15) | No Responders (n = 21) | p |
---|---|---|---|---|
Overall complications (n, %) | 9 (20.9%) | 4 (26.7%) | 8 (38.1%) | 0.354 |
Clavien Grade (n, %) | ||||
1–2 | 7 (16.3%) | 4 (26.7%) | 7 (33.3%) | 0.305 |
3–5 | 3 (7%) | 4 (26.7%) | 3 (14.3%) | 0.634 |
Median lymph node yield (n, IQR) | 27.5 (21–36.5) | 35 (23–37) | 31 (24–36) | 0.859 |
Positive surgical margins (n, %) | - | 3 (20%) | 2 (9.5%) | 0.028 |
pT stage at cystectomy | - | |||
pT0 | 43 (100%) | - | - | 0.001 |
pTa, pT1 | - | 9 (60%) | - | |
pT2a | - | 2 (13.4%) | 2 (9.5%) | |
pT2b | - | 4 (26.7%) | 3 (14.3%) | |
pT3a | - | - | 3 (14.3%) | |
pT3b | - | - | 10 (47.6%) | |
pT4 | - | - | 3 (14.3%) | |
pN | ||||
N0 | 43 (100%) | 7 (46.7%) | 12 (57.1%) | 0.001 |
N1 | - | 3 (20%) | 1 (4.8%) | |
N2 | - | 4 (26.7%) | 5 (23.8%) | |
N3 | - | 1 (6.7%) | 3 (14.3%) | |
Concomitant Cis (n, %) | - | 5 (33.3%) | 3 (14.3%) | 0.01 |
Median Follow-up (months, median, IQR) | 42 (22.5–53) | 33 (13–44.5) | 13.5 (5.2–49.5) | 0.125 |
Last control eGFR (mL/min/1.73m2, median, IQR) | 62.6 (44.8–85.2) | 59.7 (40–71.6) | 64.4 (34.4–82.9) | 0.292 |
Last control CKD (n, %) | ||||
1 | 7 (16.3%) | 1 (6.7%) | 1 (4.8%) | 0.253 |
2 | 18 (41.9%) | 6 (40%) | 11 (52.4%) | |
3a | 7 (16.3%) | 2 (13.3%) | 3 (14.3%) | |
3b | 11 (25.6%) | 4 (26.7%) | 5 (23.8%) | |
4 | - | 1 (6.7%) | 1 (4.8%) | |
5 | - | 1 (6.7%) | - | |
∆Hb (median, IQR) | 1.5 (0.6–2.6) | 1.1 (0.5–2.3) | 2.2 (0.8–2.8) | 0.598 |
Variable | Univariable Analysis | Multivariable Analysis (MIC) | ||||||
---|---|---|---|---|---|---|---|---|
HR | 95% CI | HR | 95% CI | |||||
Lower | Higher | p Value | Lower | Higher | p Value | |||
Age | 1 | 0.95 | 1.05 | 0.768 | - | - | - | - |
Gender | 0.59 | 0.22 | 1.59 | 0.303 | - | - | - | - |
ASA score 1–2 3–4 | 1.74 | 0.68 | 4.43 | 0.239 | - | - | - | - |
Smoking status | 0.98 | 0.39 | 2.4 | 0.966 | - | - | - | - |
Diabetes | 2.49 | 0.90 | 6.87 | 0.07 | - | - | - | - |
Hypertension | 3.37 | 1.31 | 8.62 | 0.01 | 2.23 | 0.83 | 6.04 | 0.111 |
Preoperative Hydronephrosis | 2.39 | 0.80 | 7.11 | 0.117 | - | - | - | - |
Type of urinary diversion (Continent vs Incontinent) | 2.20 | 0.81 | 5.96 | 0.121 | - | - | - | - |
cT stage | 1.09 | 0.45 | 2.68 | 0.837 | - | - | - | - |
Preoperative eGFR | 1 | 0.98 | 1.02 | 0.533 | - | - | - | - |
pN stage (N1 vs. N2–N3) | 2.41 | 0.53 | 10.9 | <0.001 | 10.1 | 2.3 | 44.3 | 0.002 |
Median duration from completion of NACT to RARC | 0.9 | 0.82 | 1.11 | 0.563 | - | - | - | - |
NACT (complete response vs. partial/no response) | 0.41 | 0.18 | 0.95 | 0.039 | 1.46 | 0.34 | 6.19 | 0.606 |
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Anceschi, U.; Brassetti, A.; Tuderti, G.; Ferriero, M.C.; Costantini, M.; Bove, A.M.; Calabrò, F.; Carlini, P.; Vari, S.; Mastroianni, R.; et al. Impact of Clinical Response to Neoadjuvant Chemotherapy in the Era of Robot Assisted Radical Cystectomy: Results of a Single-Center Experience. J. Clin. Med. 2020, 9, 2736. https://doi.org/10.3390/jcm9092736
Anceschi U, Brassetti A, Tuderti G, Ferriero MC, Costantini M, Bove AM, Calabrò F, Carlini P, Vari S, Mastroianni R, et al. Impact of Clinical Response to Neoadjuvant Chemotherapy in the Era of Robot Assisted Radical Cystectomy: Results of a Single-Center Experience. Journal of Clinical Medicine. 2020; 9(9):2736. https://doi.org/10.3390/jcm9092736
Chicago/Turabian StyleAnceschi, Umberto, Aldo Brassetti, Gabriele Tuderti, Maria Consiglia Ferriero, Manuela Costantini, Alfredo Maria Bove, Fabio Calabrò, Paolo Carlini, Sabrina Vari, Riccardo Mastroianni, and et al. 2020. "Impact of Clinical Response to Neoadjuvant Chemotherapy in the Era of Robot Assisted Radical Cystectomy: Results of a Single-Center Experience" Journal of Clinical Medicine 9, no. 9: 2736. https://doi.org/10.3390/jcm9092736