The investigators collected clinical data for 333 patients, of whom 48 had secondary muscle-invasive bladder cancer, and 285 had primary muscle-invasive bladder cancer. At the time of radical cystectomy, there were no significant differences in chemotherapy regimen, surgical approach, or clinical stage. Similarly, the two groups had no significant differences in relapse-free survival, cancer-specific survival, or overall survival. Significant predictors included T3/T4 disease and node-positive disease. Secondary muscle-invasive bladder cancer was not found to be a predictor of survival. Downstaging rates were also not significantly different between the two groups, and secondary muscle-invasive bladder cancer was not a negative predictor of downstaging. A multivariable regression analysis revealed that hydronephrosis was associated with decreased odds of downstaging. Benidir et al. subsequently investigated the survival outcomes in patients with secondary muscle-invasive bladder cancer who underwent radical cystectomy only and found that they had significantly worse survival outcomes than patients with primary- or secondary muscle-invasive bladder cancers who received a combination of neoadjuvant chemotherapy and radical cystectomy.
A previous study showed worse patient outcomes and lower downstaging rates in patients with secondary muscle-invasive bladder cancer who received neoadjuvant chemotherapy and underwent radical cystectomy. This difference may be related to clinical and pathological differences between these cohorts, including the percentage of patients with T4 disease. Overall, this large study by Benidir et al. provides evidence supporting the use of cisplatin-based neoadjuvant chemotherapy and radical cystectomy for patients with secondary muscle-invasive bladder cancer.
Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York City, New York
References:
- Benidir T, Lone Z, Zhang A, et al. Comparing Pathologic and Survival Outcomes Between Primary and Secondary Muscle Invasive Bladder Cancer When Treated by Radical Cystectomy With or Without Neoadjuvant Chemotherapy [published online ahead of print, 2022 Jun 28]. Urology. 2022;S0090-4295(22)00514-3. doi:10.1016/j.urology.2022.06.012
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