Introduction: Complete pathologic response (pT0) at time of cystectomy after neoadjuvant chemotherapy (NAC) has been associated with significantly improved clinical outcomes. Patients of African American race with bladder cancer have been shown to have inferior survival outcomes when compared to Caucasian patients. The goal of this study is to examine whether race is a predictor of pT0 response to NAC at time of cystectomy.
Methods: We retrospectively analyzed the records of patients diagnosed with a non-metastatic (M0) muscle-invasive (cT2+) urothelial cell bladder cancer in the National Cancer Database (NCDB) who underwent a cystectomy from 2006 to 2014. The cohort was stratified by whether the patient received NAC prior to cystectomy. Univariate and multivariate logistic regression models were used to assess for the effect of race on pathologic complete response after NAC. Similar analysis was performed on the group of patients that did not receive NAC to identify predictors specific to receipt of NAC.
Results: We identified 16,036 patients of which 3,195 patients (19.9 %) were treated with NAC prior to cystectomy. The total number of African American (AA) patients in this study was 848 (5.3% of the total cohort). There was no significant difference between Caucasian and AA patients receiving NAC in age, preoperative T and N stage, and time to cystectomy after NAC. A greater proportion of the AA patients were female (47% vs 23%, p<0.001), and had lower education and lower income. The rate of pT0 in the surgery only group was 2.7% compared to 15.0% (p < 0.001) for patients treated with NAC. On multivariate analysis, patients of African American race that received NAC were less likely to achieve pT0 (OR = 0.55, 95% CI: 0.31 – 0.98, p = 0.04) when controlling for age, sex, co-morbidities income, education and timing of cystectomy after starting NAC.
Conclusions: Our results suggest that African American patients are less likely to achieve pathologic complete response to NAC prior to cystectomy. Future prospective studies are warranted. Source of