Your browser doesn't support javascript.
loading
Clinical Upstaging After Neoadjuvant Chemotherapy Impacting Eligibility for Vaginal-sparing Cystectomy: Identifying Bladder Cancer Patients Who May Benefit From Interim Imaging.
Liu, William J; Campbell, Rebecca A; Michael, Patrick D; Wood, Andrew; Haywood, Samuel C; Eltemamy, Mohamed; Kaouk, Jihad; Campbell, Steven C; Haber, Georges-Pascal; Weight, Christopher J; Remer, Erick M; Almassi, Nima.
Afiliación
  • Liu WJ; Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
  • Campbell RA; Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
  • Michael PD; Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
  • Wood A; Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
  • Haywood SC; Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
  • Eltemamy M; Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
  • Kaouk J; Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
  • Campbell SC; Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
  • Haber GP; Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
  • Weight CJ; Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
  • Remer EM; Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Radiology, Diagnostic Institute, Cleveland Clinic, Cleveland, OH.
  • Almassi N; Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH. Electronic address: almassn2@ccf.org.
Urology ; 191: 102-109, 2024 Sep.
Article en En | MEDLINE | ID: mdl-38908561
ABSTRACT

OBJECTIVE:

Limited data exist on the frequency with which clinical progression during neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) impacts eligibility for a vaginal-sparing surgical approach or on the utility of interim imaging assessment. We sought to evaluate the incidence of clinical upstaging following NAC that would render a patient ineligible for a vaginal-sparing cystectomy.

METHODS:

Eighty-nine female patients with non-metastatic MIBC treated with NAC and radical cystectomy (RC) (2012-2023) were retrospectively reviewed. Tumor location(s) was determined from transurethral resection of bladder tumor operative reports. Pre- and post-NAC clinical staging was determined from imaging. Outcomes of interest included clinical upstaging and upstaging to vaginal invasion after NAC.

RESULTS:

75/89 patients had pre- and post-NAC imaging. Fifty-five had no change in clinical staging, 6 patients were upstaged (4 cT2→cT3, 2 cT3→cT4), and 14 patients were downstaged (13 cT3→cT2, 1 cT4→cT2). Of the 75 patients with pre- and post-NAC imaging, 39 had trigone tumors. Of these, 28 had no change in clinical staging, 2 were upstaged (1 cT2→cT3, 1 cT3→cT4) and 9 were downstaged (8 cT3→cT2, 1 cT4→cT2). Overall, 6/75 (8%) of patients demonstrated clinical upstaging after NAC. 2/39 (5%) of patients with trigone tumors clinically progressed after NAC and both had vaginal invasion (pT4) on final pathology.

CONCLUSION:

Although clinical upstaging after NAC was infrequent, 5% of patients with trigonal MIBC were rendered ineligible for vaginal-sparing cystectomy following NAC due to progression. Interim imaging assessment may identify non-responders and preserve eligibility for vaginal-sparing RC.
Asunto(s)
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vagina / Neoplasias de la Vejiga Urinaria / Cistectomía / Terapia Neoadyuvante / Tratamientos Conservadores del Órgano / Estadificación de Neoplasias Límite: Aged / Female / Humans / Middle aged Idioma: En Revista: Urology Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vagina / Neoplasias de la Vejiga Urinaria / Cistectomía / Terapia Neoadyuvante / Tratamientos Conservadores del Órgano / Estadificación de Neoplasias Límite: Aged / Female / Humans / Middle aged Idioma: En Revista: Urology Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos