Dataset Information

Survival benefit of neoadjuvant chemotherapy in pathologic T2N0 or lower urothelial carcinoma patients: evidence to support the use of neoadjuvant chemotherapy.

ABSTRACT:

Background

To evaluate the survival benefit of neoadjuvant chemotherapy (NAC) in pathologic T2N0 or less patients.

Methods

A total of 526 patients with less than pT2N0 underwent radical cystectomy. Patients were divided into three groups: non-NAC, those who did not receive NAC; partial NAC, those who received less 3 cycles of NAC; and complete NAC, those who received 3 cycles of NAC.

Results

Median follow up was 74.6 (range, 24-311) months. Recurrent-free survival (RFS) was significantly (P=0.041) higher in the non-NAC group than that in the complete NAC group. Overall survival (OS) was significantly (P=0.039) higher in the non-NAC group than that in the complete NAC group. There was no significant difference between the partial NAC group and the complete NAC group. In patients with pT0, the NAC group had higher pT0 ratio than the non-NAC group (33.3% vs. 21.1%). A total of 66.6% of NAC patients were down-staged to less than T2. In univariate and multivariate analyses, recurrence was significantly related to pathologic T stage (P<0.001), concurrent carcinoma in situ (CIS) (P=0.002), and the number of removed lymph nodes (LNs) (P=0.001). Survival was significantly related to pathologic T stage (P<0.001), lymphovascular invasion (LVI) (P=0.002), the number of removed LNs (P<0.001), and the presence of NAC (P=0.047).

Conclusions

Patients with pT2 or lower underwent NAC showed similar prognosis as patients with pT2 or lower who did not undergo NAC.

SUBMITTER: Yuk HD

PROVIDER: S-EPMC7354338 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Survival benefit of neoadjuvant chemotherapy in pathologic T2N0 or lower urothelial carcinoma patients: evidence to support the use of neoadjuvant chemotherapy.

Yuk Hyeong Dong HD Jeong Chang Wook CW Kwak Cheol C Kim Hyeon Hoe HH Ku Ja Hyeon JH

Translational andrology and urology 20200601 3

<h4>Background</h4>To evaluate the survival benefit of neoadjuvant chemotherapy (NAC) in pathologic T2N0 or less patients.<h4>Methods</h4>A total of 526 patients with less than pT2N0 underwent radical cystectomy. Patients were divided into three groups: non-NAC, those who did not receive NAC; partial NAC, those who received less 3 cycles of NAC; and complete NAC, those who received 3 cycles of NAC.<h4>Results</h4>Median follow up was 74.6 (range, 24-311) months. Recurrent-free survival (RFS) was ...[more]

PMID: 32676410

Similar Datasets

Project description:Importance:Adjuvant chemotherapy (AC) in patients with rectal cancer with pathologic complete response following neoadjuvant chemoradiotherapy (nCRT) and resection is recommended by treatment guidelines. However, its role in this setting is equivocal because data supporting benefits are lacking. Objective:To compare the overall survival (OS) between AC and postoperative observation (OB) in patients with rectal cancer with pathologic complete response following nCRT and resection. Design, Setting, and Participants:We identified a cohort of patients with rectal cancer and a complete pathological response (ypT0N0) after nCRT in the National Cancer Database between 2006 and 2012. Patients who received AC were compared with OB patients by propensity score matching. Overall survival was compared using the stratified log-rank test and stratified Cox regression model. The outcomes after AC vs OB were also evaluated in patient subgroups. The data analysis was completed in June 2017. Exposures:Adjuvant chemotherapy and OB. Main Outcomes and Measures:Overall survival. Results:We identified 2764 patients (mean [SD] age, 60.0 [12.3] years; 40% female) with clinical stage II or III resected adenocarcinoma of the rectum who had received nCRT and were complete responders (ypT0N0M0). Of this cohort, 741 patients in the AC group were matched by propensity score to 741 patients who underwent OB. The AC cohort had better OS compared with the OB cohort (hazard ratio, 0.50; 95% CI, 0.32-0.79). The 1-, 3-, and 5-year OS rates were 99.7%, 97.1%, and 94.7% for the AC group and 99.2%, 93.6%, and 88.4% for the OB group (P = .005). In subgroup analysis, patients with clinical stage T3/T4 and node-positive disease benefited most from AC (hazard ratio, 0.47; 95% CI, 0.25-0.91). Conclusions and Relevance:Adjuvant chemotherapy was associated with improved OS in patients with pathologic complete response after nCRT for resected locally advanced rectal cancer. This study supports the use of AC in this setting where there is currently paucity of data.

Project description:The purpose of this study is to develop a prediction model utilizing tumor hemoglobin parameters measured by ultrasound-guided near-infrared optical tomography (US-NIR) in conjunction with standard pathologic tumor characteristics to predict pathologic response before neoadjuvant chemotherapy (NAC) is given.Thirty-four patients' data were retrospectively analyzed using a multiple logistic regression model to predict response. These patients were split into 30 groups of training (24 tumors) and testing (12 tumors) for cross validation. Tumor vascularity was assessed using US-NIR measurements of total hemoglobin (tHb), oxygenated (oxyHb) and deoxygenated hemoglobin (deoxyHb) concentrations acquired before treatment. Tumor pathologic variables of tumor type, Nottingham score, mitotic index, the estrogen and progesterone receptors and human epidermal growth factor receptor 2 acquired before NAC in biopsy specimens were also used in the prediction model. The patients' pathologic response was graded based on the Miller-Payne system. The overall performance of the prediction models was evaluated using receiver operating characteristic (ROC) curves. The quantitative measures were sensitivity, specificity, positive and negative predictive values (PPV and NPV) and the area under the ROC curve (AUC).Utilizing tumor pathologic variables alone, average sensitivity of 56.8%, average specificity of 88.9%, average PPV of 84.8%, average NPV of 70.9% and average AUC of 84.0% were obtained from the testing data. Among the hemoglobin predictors with and without tumor pathological variables, the best predictor was tHb combined with tumor pathological variables, followed by oxyHb with pathological variables. When tHb was included with tumor pathological variables as an additional predictor, the corresponding measures improved to 79%, 94%, 90%, 86% and 92.4%, respectively. When oxyHb was included with tumor variables as an additional predictor, these measures improved to 77%, 85%, 83%, 83% and 90.6%, respectively. The addition of tHb or oxyHb significantly improved the prediction sensitivity, NPV and AUC compared with using tumor pathological variables alone.These initial findings indicate that combining widely used tumor pathologic variables with hemoglobin parameters determined by US-NIR may provide a powerful tool for predicting patient pathologic response to NAC before the start of treatment.ClincalTrials.gov ID: NCT00908609 (registered 22 May 2009).

Dataset Information

Survival benefit of neoadjuvant chemotherapy in pathologic T2N0 or lower urothelial carcinoma patients: evidence to support the use of neoadjuvant chemotherapy.

Background

Methods

Results

Conclusions

Publications

Survival benefit of neoadjuvant chemotherapy in pathologic T2N0 or lower urothelial carcinoma patients: evidence to support the use of neoadjuvant chemotherapy.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets