Category: Clinical Oncology: Outcomes & Complications

MP23-8 - The long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy combined with radical cystectomy versus radical cystectomy alone for muscle-invasive bladder cancer: a propensity-score matching study

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective : Although neoadjuvant cisplatin-based combination chemotherapy followed by radical cystectomy (RC) was advised on high-level evidence for resectable muscle-invasive bladder cancer (MIBC), the toxicities and the potential harm might delay the RC. This study evaluated the long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy(IAC) combined with RC compared to RC alone for MIBC.


Methods : We performed a retrospective review of patients who underwent either one-shot neoadjuvant IAC or No-IAC(NIAC) before RC between February 2006 to December 2015. To reduce the inherent biases of a retrospective study, IAC and NIAC groups were matched on the basis of key variables. The propensity-score matching algorithm was 1:3.


Results : A total of 26 patients were treated with IAC and 123 with NIAC during the study period. After a propensity-score matching, there was no significant difference between the IAC (n=26) and NIAC (n=78) groups for follow-up length (88.0 vs 56.0, p=0.161 ), type of urinary diversion (p=0.840), operating time (369.0 vs 382.9 min; p=0.574), estimated blood loss (411.5 vs 348.1 ml; p=0.456), adjuvant chemotherapy (4 vs 12 n, p=1.000), pathologic stage (p=0.414), histology grade (p=0.566), median nodes removed (17 vs 14 n; p=0.304), positive surgical margins (0 vs 3 n; p=0.571) and overall complications (24 vs 75; p=0.791). There was no significant difference in cancer-specific survival (CSS, p=0.439) or overall survival (OS, p=0.354) between the IAC and NIAC groups. On Cox proportional hazards regression analysis, BMI (p=0.005), diabetes (p=0.002), ASA score (p=0.005), lymph node positive (LNP, p=0.000), and perioperative complications (p=0.020) were associated with OS in all sample (n=104); diabetes in IAC group (p=0.029); BMI (p=0.015), LNP (p=0.000) and smoking (p=0.043) in NIAC group. Using these potential factors to analyze Kaplan-Meier survival curve: BMI (by a 25 kg/m 2 ) associated with OS (p=0.004), LNP associated with OS (p<0.001) and CSS (p=0.010) in all sample group; diabetes associated with OS (p=0.004) in IAC group; BMI associated with OS (p=0.014), LNP associated with OS (p<0.001) and CSS (p=0.017) in NIAC group.


Conclusions : Patients treated with one-shot neoadjuvant IAC before RC did not significantly improve CSS and OS compared to those treated without IAC. BMI and LNP were significant affect the prognosis. The multimodal treatment algorithm for MIBC is still needs further exploration.

Wasilijiang Wahafu

Department of Urology
Beijing Chao-Yang Hospital
Beijing, Beijing, China (People's Republic)

Sai Liu

Beijing, Beijing, China (People's Republic)

Mengtong Wang

Beijing, Beijing, China (People's Republic)

Qingbao He

Beijing, Beijing, China (People's Republic)

Liming Song

Beijing, Beijing, China (People's Republic)

Hao Ping

Beijing, Beijing, China (People's Republic)

Mingshuai Wang

Beijing, Beijing, China (People's Republic)

Feiya Yang

Beijing, Beijing, China (People's Republic)

Yinong Niu

Beijing, Beijing, China (People's Republic)

Nianzeng Xing

Director of Urologic Department
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
Beijing, Beijing, China (People's Republic)

Professor Nianzeng Xing (M.D., Ph.D.) is the director of the department of Urology in National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. He is expert in laparoscopic surgery. Untill now, he have published 50 English papers and 150 Chinese papers, and obtained many medicine awards in China.