MIBC: 2-month or more NACT delay tied to upstaging

  • Audenet F & al.
  • Urol Oncol
  • 30 Nov 2018

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with muscle-invasive bladder cancer (MIBC), neoadjuvant chemotherapy (NACT) delay of ≥8 weeks was associated with increased risk of upstaging.
  • A delay for RC ≥6 months was not associated with worse OS in patients receiving NACT.
  • The authors do not support skipping NACT to avoid RC delay, as long as RC is performed within 7 months from the initial diagnosis. 

Why this matters

  • Only 20% of patients receive NACT before RC, despite recommendations.

Study design

  • 2227 patients with cT2-T4aN0M0 bladder cancer underwent NACT and RC during 2004-2014.
  • Funding: None.

Key results

  • Median follow-up, 45.7 months.
  • Median times from diagnosis to NACT and RC were 39 and 155 days, respectively.
  • NACT delay of ≥8 weeks was associated with increased risk of upstaging (OR, 1.27; P=.031).
  • 41% of patients (including 22% with lymph nodes) were upstaged after RC.
  • Significant predictors of treatment delay were:
    • African-American race (OR, 2.10; P<.001>
    • Medicaid or other government insurance (OR, 1.53; P=.046), and
    • treatment at academic facilities (OR, 1.24; P=.047).
  • No significant cutoff point for worse OS was identified for time to RC up to 222 days.
  • A delay for RC ≥6 months was not associated with worse OS.

Limitations

  • Retrospective design.

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