KEY TAKEAWAYS
- The study aimed to assess the impact of NAC on survival in octogenarians undergoing RC for patients with MIBC.
- Researchers noticed that NAC with RC improves OS in octogenarians, with responders faring better than non-responders.
Neoadjuvant chemotherapy (NAC) combined with radical cystectomy (RC) is widely recognized as the standard treatment for localized muscle-invasive bladder cancer (MIBC). Despite its efficacy, older patients, especially those in their eighties, are less frequently administered NAC.
Arjun Pon Avudaiappan and the team aimed to explore the use of NAC with RC in octogenarians, assessing its impact on survival outcomes and comparing the efficacy between those who responded to NAC and those who did not.
They performed an inclusive analysis using the National Cancer Database (NCDB) to identify octogenarians with MIBC and urothelial histology who underwent RC with or without NAC between 2004 and 2018. The NAC cohort included patients who received RC with NAC, while the non-NAC cohort comprised those who underwent RC with or without adjuvant chemotherapy.
The NAC cohort was further categorized into responders and non-responders based on surgical pathology. Patients with a comorbidity index > 1, indicating possible renal impairment, were excluded. After propensity matching, researchers compared overall survival (OS) between the NAC and non-NAC cohorts, as well as between responders and non-responders.
About 33,924 patients underwent RC, and 3,056 octogenarians met the selection criteria. Among them, 396 received NAC, while 2,660 did not. Among those who received NAC, 112 (28.3%) experienced downstaging, and 223 (56.4%) exhibited upstaging or no change (P < 0.001).
After propensity matching, the median OS for the NAC cohort was 51.6 months compared to 31.3 months for the non-NAC cohort (P < 0.001). Similarly, the median OS for responders was 89.4 months, whereas non-responders had a median OS of 26.5 months (P < 0.0001).
The study concluded that NAC combined with RC for MIBC may improve OS among healthy octogenarians. Additionally, responders to NAC exhibited significantly better OS compared to non-responders.
Funding was not applicable.
Source: https://pubmed.ncbi.nlm.nih.gov/39049001/
Avudaiappan AP, Prabhakar P, Sandman MS, et al. (2024). “Pathological response and survival outcomes after neoadjuvant chemotherapy with radical cystectomy in octogenarians for muscle-invasive bladder cancer: an observational database study.” BMC Urol. 2024 Jul 24;24(1):150. doi: 10.1186/s12894-024-01548-y. PMID: 39049001; PMCID: PMC11267756.
