According to the AUA/ASCO/ASTRO/SUO Guideline on treatment of nonmetastatic muscle-invasive bladder cancer (MIBC), females requiring radical cystectomy (RC) should undergo concomitant anterior pelvic exenteration despite low rates of malignant involvement of gynecologic organs. We present the clinicopathological characteristics of patients with MIBC treated with neoadjuvant chemotherapy (NAC) and evaluate the impact of NAC on gynecologic organ involvement (GOI).
An IRB approved review of patients with cT2-T3 MIBC treated with RC at our institution between 2005-2018 was performed. Patients were stratified by receipt of NAC.
186 females with cT2-3 MIBC underwent RC during the study period, 67.7% received NAC prior to RC. Patients who received NAC were more likely to have cT3 disease, pre-operative hydronephrosis, and variant histology on transurethral resection (p <0.001, p=0.004, p=0.029, respectively). Rates of recurrence or metastasis were similar between groups (27.0% vs. 26.7%, p=0.964). No patients had isolated genitourinary organ recurrence (median follow-up 32.1 months). Nine patients (5.7%) had GOI (6 NAC vs. 3 no NAC, p=0.978). Among those who underwent hysterectomy, two patients (3.1%) who received NAC had uterine involvement compared to none in the no NAC cohort (p=0.551). Rates of vaginal involvement were similar between the groups (4 NAC vs. 3 no NAC, p=0.402). Additionally, one patient who received NAC had incidentally diagnosed localized endometrial cancer. No women had fallopian tube or ovarian involvement.
Even amongst high risk patients with MIBC, GOI of MIBC is rare and organ preservation, especially of the ovaries, is likely safe.
The Journal of urology. 2021 Apr 19 [Epub ahead of print]
Kelly K Bree, Patrick J Hensley, Mary Beth Westerman, Andrea Kokorovic, Graciela M Nogueras Gonzalez, Colin P Dinney, Ashish M Kamat, Neema Navai
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas.