Clinical Oncology: Outcomes & Complications

Moderated Poster Session

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

Saturday, September 22
2:00 PM - 4:00 PM
Location: Room 253

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

Dr. Wasilijiang Wahafu, M.D., associate chief physician in Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University.

EDUCATION and CLINICAL EXPERIENCE
1. Visting scholar in Department of Urology, Heidelberg University Hospital, Aug. 2018 - present
2. Associate chief physician in Department of Urology, Beijing Chao-Yang Hospital, Jun. 2014 - present
3. Department of Urology, Chinese PLA General Hospital, Postdoctoral of Medical Science in Urology, Sept. 2011- May. 2014
4. Department of Urology, Peking University First Hospital, Doctor of Medical Science in Urology, Sep. 2006- Jul. 2011
5. Physician in surgical departments at Xinjiang Uygur Autonomous Region People's Hospital, Sep. 2004 - Aug. 2006
6. Xi’an Jiaotong University College of Medicine, Bachelor of Medical Science, Sep.1999 – Jul. 2004

Articles (first author only)
1. Wahafu W, He ZS, et al. The nucleosome binding protein NSBP1 is highly expressed in human bladder cancer and promotes the proliferation and invasion of bladder cancer cells. Tumour Biol. 2011. 32(5): 931-939
2. Wahafu W, Xin Ma, et al. Evolving Renorrhaphy Technique in Retroperitoneal Laparoscopic Partial Nephrectomy: A Single-surgeon Experience. International Journal of Urology Official Journal of the Japanese Urological Association, 2014, 21(9):865-73.
3. Wahafu W, Junwei G, et al. Increased expression of hydrogen sulfide and its synthases in urothelial cell carcinoma of the urinary bladder tissue and inhibition of hydrogen sulfide enhanced cisplatin-induced apoptosis in EJ cells. Oncology Letters. 2018. 15: 8484-8490

Fund
1. 2014-2016 The National Natural Science Foundation of China (cat. 81302231) : The expression and molecular mechanism of membrane protein Presenilin in urothelial cell carcinoma of the bladder
2. 2015-2016 The Beijing Outstanding Talent Training (cat. 2014000021469G234): Expression of MIF/CD74 in bladder cancer and its malignant progression
3. 2017-2018 Beijing Municipal Administration of Hospitals‘ Youth Programme (cat. QML20160303): WTp53 regulated senescence inhibits the apoptotic response to cisplatin resistance in bladder cancer

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    Sai Liu

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      Mengtong Wang

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        Qingbao He

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          Liming Song

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            Hao Ping

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              Mingshuai Wang

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                Feiya Yang

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                  Yinong Niu

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                    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

                    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.

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                      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



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