Current guidelines endorse the use of perioperative chemotherapy (POC) in muscle-invasive bladder cancer (MIBC) to enhance the long-term overall survival (OS) compared to radical cystectomy (RC) alone. This study aims to assess the impact of POC on the OS in frail and morbid (F-M) patients undergoing RC.
A retrospective multicenter study of 291 patients who underwent RC between 2015 and 2019 was performed. Patients with both a Charlson comorbidity index ≥ 4 and Modified Frailty Index ≥ 2 were classified as the F-M cohort. We compared the clinical and pathological characteristics and outcomes of the F-M patients who received POC to those who underwent RC alone. Univariable and multivariable analyses were performed to identify the predictors of the OS.
The F-M cohort included 102 patients. POC was administered to 44% of these patients: neoadjuvant (NAC) to 31%, adjuvant (AC) to 19%, and both to 6 (6%). The OS was significantly lower in the F-M cohort compared to in the healthier patients (median OS 42 months, p = 0.02). The F-M patients who received POC were younger, less morbid and had better renal function. Although POC was marginally associated with improved OS in the univariable analysis (p = 0.06), this was not significant in the multivariable analysis (p = 0.50). NAC was associated with improved OS in the univariable analysis (p = 0.004) but not after adjustment for competing factors (p = 1.00). AC was not associated with the OS.
POC does not improve the OS in F-M patients undergoing RC. Personalized treatment strategies and further prospective studies are needed to optimize care in this unique vulnerable population.
Journal of personalized medicine. 2024 Sep 09*** epublish ***
Ziv Savin, Lin Levin, Alon Lazarovich, Barak Rosenzweig, Reut Shashar, Azik Hoffman, Jonathan Gal, Miki Haifler, Ilona Pilosov, Yuval Freifeld, Sagi Arieh Shpitzer, Shay Golan, Roy Mano, Ofer Yossepowitch
Department of Urology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel., Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel., Department of Urology, Chaim Sheba Medical Center, Tel-Aviv University, Ramat Gan 5266202, Israel., Department of Urology, Rambam Health Center, Technion Israel Institute of Technology, Haifa 3109601, Israel., Israeli Urologic Oncology Collaboration (IUOC)., Department of Urology, Shamir Medical Center, Tel-Aviv University, Tel Aviv 6997801, Israel., Department of Urology, Carmel Medical Center, Technion Israel Institute of Technology, Haifa 3436212, Israel., Department of Urology, Rabin Medical Center, Tel-Aviv University, Petach-Tikva 4941492, Israel.