While it has been demonstrated that receipt of neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) improves survival compared to RC alone, the driving factor for this benefit may be from patients with ypT0 status at surgery. Meanwhile, the implications of having residual urothelial carcinoma of the bladder (rUCB) at RC after NAC are less clear. We therefore evaluated whether survival differed between patients with rUCB at RC after NAC and stage-matched controls who underwent RC alone. Patients who underwent NAC + RC (n = 180) were matched to controls who underwent RC alone (n = 324) on the basis of pT and pN stage, margin status, and year of RC. The 5-yr recurrence-free survival (RFS; 90% vs 94%; p = 1), cancer-specific survival (CSS; 82% vs 93%; p = 0.4), and overall survival (OS; 82% vs 82%; p = 0.5) were not significantly different between the NAC and control groups for patients with ypT0N0/pT0N0 disease (n = 103). Conversely, among patients with rUCB at RC (n = 401), patients who received NAC had significantly worse 5-yr RFS (50% vs 63%; p = 0.01), CSS (40% vs 59%; p = 0.003), and OS (33% vs 48%; p = 0.02). On multivariable analysis for patients with rUCB, NAC receipt remained independently associated with worse RFS (hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.28–2.66; p = 0.001), CSS (HR 1.81, 95% CI 1.30–2.52; p < 0.001), and OS (HR 1.57, 95% CI 1.18–2.08; p = 0.002). Limitations include potential for selection bias owing to the retrospective observational design. Thus, while patients who achieve a complete response to NAC have excellent survival outcomes, those with rUCB after NAC have a worse prognosis compared to stage-matched controls undergoing RC alone. It may be worthwhile considering these patients for clinical trials evaluating the role of additional treatments after RC using newer agents while we await further research on predicting which patients achieve ypT0 status from NAC before RC.

Patient summary

On surgical removal of the bladder, patients without residual bladder cancer after neoadjuvant chemotherapy have excellent survival outcomes. However, patients with residual cancer after neoadjuvant chemotherapy and surgery have worse outcomes compared to patients undergoing surgery alone. These patients should therefore be considered for additional treatments after surgery using newer agents while we await further research on predicting which patients will benefit from neoadjuvant chemotherapy before bladder removal for cancer.

中文翻译：

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新辅助化疗后膀胱切除术中残留癌患者的肿瘤学结局：病理学阶段匹配分析

尽管已经证明，与单独使用RC相比，在根治性膀胱切除术（RC）之前接受新辅助化疗（NAC）可以提高生存率，但获得这种益处的驱动因素可能是手术时处于ypT0状态的患者。同时，NAC后在RC残留膀胱尿路上皮癌（rUCB）的含义尚不清楚。因此，我们评估了在NAC后接受RC治疗的rUCB患者与仅接受RC的阶段匹配对照之间的生存率是否存在差异。 根据pT和pN分期，切缘状态和RC年，将接受NAC + RC（n = 180）的患者与仅接受RC（n = 324）的对照相匹配。5年无复发生存率（RFS; 90％vs 94％; p  = 1），癌症特异性生存率（CSS; 82％vs 93％;p  = 0.4）和 ypT0N0 / pT0N0疾病患者的总生存率（OS； 82％vs 82％；p = 0.5）在NAC组和对照组之间无显着差异（n  = 103）。相反，在RC中使用rUCB的患者中（n  = 401），接受NAC的患者5年期RFS明显较差（50％vs 63％；p  = 0.01），CSS（40％vs 59％; p  = 0.003），和OS（33％vs 48％；p  = 0.02）。在对rUCB患者进行多变量分析时，NAC的接受仍然独立于RFS恶化（危险比[HR] 1.84，95％置信区间[CI] 1.28–2.66；p  = 0.001），CSS（HR 1.81，95％CI 1.30– 2.52; p <0.001）和OS（HR 1.57，95％CI 1.18–2.08；p  = 0.002）。局限性包括由于回顾性观察设计而导致选择偏见的可能性。因此，尽管对NAC完全反应的患者具有出色的生存结局，但与仅接受RC的阶段匹配对照相比，NAC后使用rUCB的患者预后较差。可能有必要考虑这些患者进行临床试验，以评估使用新药进行RC后其他治疗的作用，而我们等待进一步的研究来预测哪些患者在RC前通过NAC达到ypT0状态。

病人总结

在手术切除膀胱时，新辅助化疗后无残留膀胱癌的患者具有优异的生存结局。但是，与仅接受手术的患者相比，在新辅助化疗和手术后残留癌症的患者的预后较差。因此，这些患者术后应考虑使用更新的药物进行其他治疗，同时我们等待进一步的研究，以预测哪些患者将从膀胱癌切除术之前的新辅助化疗中受益。