Incidence and Effect of Thromboembolic Events in Radical Cystectomy Patients Undergoing Preoperative Chemotherapy for Muscle-invasive Bladder Cancer

Introduction: Neoadjuvant chemotherapy (NAC) confers a significant survival benefit in patients with muscle invasive bladder cancer. Platinum-based chemotherapy increases the risk of thromboembolic events (TEE). We determined the effect of cisplatin-based NAC on the incidence of preoperative TEEs in radical cystectomy patients. Materials and Methods: A retrospective matched case-control study was performed on 55 patients undergoing radical cystectomy for muscle invasive bladder cancer. Group 1 (n = 20) included patients that received NAC prior to radical cystectomy and Group 2 (n = 35) included patients that underwent radical cystectomy without NAC. Logistic regression analyses tested potential predictors for TEEs in both groups (age, American Society of Anesthesiologists grade, use of NAC, histological subtype, pathological stage). Results: In total, 6 patients of 55 developed a TEE. Five patients of 20 (25%) treated with NAC prior to radical cystectomy developed TEEs, while 1 of 35 (2.9%) treated with radical cystectomy alone developed a TEE. On univariate and multivariate regression analysis, NAC prior to radical cystectomy was an independent predictor for TEE prior to radical cystectomy (p = 0.033 and p = 0.043, respectively). The effect of perioperative anticoagulation on operative blood loss and postoperative hemoglobin level was not statistically significant between both groups (p = 0.22 and p = 0.08, respectively). Conclusion: Neoadjuvant cisplatin-based chemotherapy is a significant predictor for preoperative TEE in patients undergoing radical cystectomy.

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No increased risk of short-term complications after radical cystectomy for muscle-invasive bladder cancer among patients treated with preoperative chemotherapy: a nation-wide register-based study

World Journal of Urology ◽

10.1007/s00345-019-02770-2 ◽

2019 ◽

Vol 38 (2) ◽

pp. 381-388 ◽

Cited By ~ 3

Author(s):

Tomas Jerlström ◽

Ruoqing Chen ◽

Fredrik Liedberg ◽

Ove Andrén ◽

Viveka Ströck ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Preoperative Chemotherapy ◽

Invasive Bladder Cancer ◽

Short Term ◽

Muscle Invasive Bladder Cancer ◽

Increased Risk ◽

Muscle Invasive

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789 Adjuvant chemotherapy after radical cystectomy for muscle-invasive bladder cancer: A comparative study using inverse-probability-of-treatment weighting (IPTW)

European Urology Supplements ◽

10.1016/s1569-9056(14)60777-6 ◽

2014 ◽

Vol 13 (1) ◽

pp. e789

Author(s):

T. Kwon ◽

I.G. Jeong ◽

D. You ◽

B. Lim ◽

K-S. Han ◽

...

Keyword(s):

Bladder Cancer ◽

Adjuvant Chemotherapy ◽

Comparative Study ◽

Radical Cystectomy ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Inverse Probability ◽

Muscle Invasive

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Association of age with response to preoperative chemotherapy in patients with muscle-invasive bladder cancer

World Journal of Urology ◽

10.1007/s00345-021-03793-4 ◽

2021 ◽

Author(s):

David D’Andrea ◽

Peter C. Black ◽

Homayoun Zargar ◽

Kamran Zargar-Shoshtari ◽

Francesco Soria ◽

...

Keyword(s):

Bladder Cancer ◽

Preoperative Chemotherapy ◽

Objective Response ◽

Pathologic Complete Response ◽

Invasive Bladder Cancer ◽

Survival Outcomes ◽

Muscle Invasive Bladder Cancer ◽

Patient Age ◽

Patient Âgé ◽

Muscle Invasive

Abstract Purpose To assess the association of patient age with response to preoperative chemotherapy in patients with muscle-invasive bladder cancer (MIBC). Materials and methods We analyzed data from 1105 patients with MIBC. Patients age was evaluated as continuous variable and stratified in quartiles. Pathologic objective response (pOR; ypT0-Ta-Tis-T1N0) and pathologic complete response (pCR; ypT0N0), as well survival outcomes were assessed. We used data of 395 patients from The Cancer Genome Atlas (TCGA) to investigate the prevalence of TCGA molecular subtypes and DNA damage repair (DDR) gene alterations according to patient age. Results pOR was achieved in 40% of patients. There was no difference in distribution of pOR or pCR between age quartiles. On univariable logistic regression analysis, patient age was not associated with pOR or pCR when evaluated as continuous variables or stratified in quartiles (all p > 0.3). Median follow-up was 18 months (IQR 6–37). On Cox regression and competing risk regression analyses, age was not associated with survival outcomes (all p > 0.05). In the TCGA cohort, patient with age ≤ 60 years has 7% less DDR gene mutations (p = 0.59). We found higher age distribution in patients with luminal (p < 0.001) and luminal infiltrated (p = 0.002) compared to those with luminal papillary subtype. Conclusions While younger patients may have less mutational tumor burden, our analysis failed to show an association of age with response to preoperative chemotherapy or survival outcomes. Therefore, the use of preoperative chemotherapy should be considered regardless of patient age.

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