Article
The influence of radiological remission in interim staging during NAC on the pathological tumor stage and prognosis in patients with MIBC
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Authors
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Sofiya Semko
- Universitätsklinikum Köln, Klinik für Urologie, Uro-Onkologie, roboter-assistierte und spezielle urologische Chirurgie, Köln, Deutschland
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Constantin Rieger
- Universitätsklinikum Köln, Klinik für Urologie, Uro-Onkologie, roboter-assistierte und spezielle urologische Chirurgie, Köln, Deutschland
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Maksym Pikul
- Universitätsklinikum Köln, Klinik für Urologie, Uro-Onkologie, roboter-assistierte und spezielle urologische Chirurgie, Köln, Deutschland
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David Pfister
- Universitätsklinikum Köln, Klinik für Urologie, Uro-Onkologie, roboter-assistierte und spezielle urologische Chirurgie, Köln, Deutschland
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Axel Heidenreich
- Universitätsklinikum Köln, Klinik für Urologie, Uro-Onkologie, roboter-assistierte und spezielle urologische Chirurgie, Köln, Deutschland
| Published: | April 2, 2025 |
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Outline
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Objective: The aim of the study was to investigate the influence of the tumor response observed in imaging during interim staging (IS) after 2 cycles of NAC on the final response and disease prognosis.
Materials and methods: 99 patients with MIBC (>pT2 cN+), who were eligible for cisplatin and received NAC with 4 cycles of gemcitabine/cisplatin from 2015 to 2024, were retrospectively analyzed. All patients underwent imaging-based staging after 2 and 4 cycles of therapy. The evaluation was performed according to RECIST criteria and divided into subgroups (SD: stable disease, PR: partial response, CR: complete response). 25 patients were excluded due to inconsistent data. The pathological stage after NAC, complications according to the Clavien-Dindo classification, 1-year progression-free survival (PFS), and overall survival (OS) were evaluated.
Results: 10 out of 74 patients (14%) showed a CR, 29 (39%) - PR, while 35 cases (47%) had SD. All patients with CR on IS showed a ypT0/T1ypN0 finding during radical cystectomy (rCx). 20 out of 29 patients (69%) with PR on IS had a ypT0ypN0 finding at rCx. 22 out of 35 patients (63%) with SD on IS had a pT2 finding or even increased pT/pN staging during rCx, while 12 out of 35 (34%) showed clinical disease progression. Detailed response information is highlighted in Table 1 [Tab. 1]. The Clavien-Dindo complication rate of grades ≥III after rCx were seen in 27% and 33% of cases in the PR/CR and SD groups respectively (p>0.05). The 1-year PFS in the PR/CR group was 79% compared to 63% in the SD group on IS (p<0.05). The 1-year OS was 90% in the PR/CR group compared to 74% in the SD group (p<0.05).
Conclusion: Patients with PR/CR in interim staging show a high response rate during radical cystectomy as well as significantly better PFS and OS compared to those with SD. We consider interim staging to be important for prognosis assessment. If current data would be further validated, an SD after 2 cycles of nCHT could lead to a switch of systemic therapy.
