Article
Clinical parameters predicting complete pathological response using platinum-based chemotherapy in muscle-invasive bladder cancer
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Authors
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Constantin Rieger
- Urologie Uniklinik Köln, Köln, Germany
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Katharina Lampkemeyer
- Urologie Uniklinik Köln, Köln, Germany
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Lucas Kastner
- Urologie Uniklinik Köln, Köln, Germany
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David Pfister
- Urologie Uniklinik Köln, Köln, Germany
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Axel Heidenreich
- Urologie Uniklinik Köln, Köln, Germany
| Published: | March 28, 2023 |
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Outline
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Introduction: Neoadjuvant chemotherapy (NAC) is the international gold standard in non-metastatic muscle-invasive bladder cancer (MIBC) prior to radical cystectomy. Nevertheless, not all patients profit to the same extent. Therefore, in times of personalized medicine, molecular and clinical predictors are needed to avoid drug-related toxicities and delaying cystectomy.
Methods: We performed a retrospective single-center study enrolling 76 patients with non-metastatic MIBC who received 3–4 cycles gemcitabine + cisplatin prior to cystectomy. Patients were stratified into two groups: complete pathological responders (ypT0, N0) and non-responders (≤ ypT1). Blood tests, medical history, and treatment-related adverse events were analyzed using student’s t-test, Fisher’s exact test, and chi-squared test.
Results: 39% (n=29) of patients showed complete pathological response. There was no significant difference between the two groups in terms of various clinicopathological characteristics (age, sex, allergies, cardiovascular events, medication, former surgery such as appendectomy). In contrast, thyroid gland dysfunction (either hypo- or hyperthyroidism) was significantly less common in responders (p=0.027; responders: 1; non-responders: 10). Neutropenia as a chemotherapy-related adverse event occurred more frequently in responders (p=0.033; responders: 9; non-responders: 5). In terms of laboratory parameters, albumin (responders: 44.2; non-responders: 40.8, p=<0.001), fibrinogen (responders: 5.4 g/L; non-responders: 4.5 g/L), album-fibrinogen-ratio responders: 10.1; non-responders: 7.9, p=0.016) and hemoglobin (responders: 13.7; non-responders: 11.3; p=0.006) were significantly higher in responders prior to the first cycle of chemotherapy.
Conclusion: Higher levels of hemoglobin and albumin prior to the first cycle of NAC are significantly associated with complete pathological response in cystectomy specimens and could hence support decision-making on whether to administer NAC in patients with MIBC. Furthermore, the results of our study showed a significant correlation between thyroid gland dysfunction or lower incidences of neutropenia and non-responders, which could be investigated further in future studies.
