Overall survival of patients with muscle-invasive bladder cancer treated with chemotherapy
Abstract
Introduction: Survival of patients with muscle-invasive bladder cancer continues to be low despite the treatments incorporated in the last two decades.
Objective: Evaluate overall survival according to clinical and histopathological characteristics and treatment.
Methods: An observational retrospective study was conducted of 240 patients diagnosed with muscle-invasive bladder cancer treated at Hermanos Ameijeiras Clinical Surgical Hospital from 2015 to 2019. Overall survival was evaluated with the Kaplan-Meier method. Curves were compared using Log Rank and Breslow's tests with a significance level of 0.05 and a confidence interval of 95%.
Results: Mean age was 66.3 years (± 9.5). A predominance was found of patients aged over 65 years, male sex, white skin color, Eastern Cooperative Oncology Group 2 at diagnosis, tobacco consumption, associated cardiovascular disease, and hemoglobin and creatinine levels within normal limits. The most common presentation symptom was hematuria. Mean overall survival was 27.13 months (CI 95%: 24.3; 30.0). Overall survival was greater in patients with Eastern Cooperative Oncology Group 0-1, normal hemoglobin and creatinine levels at diagnosis, tumors classified as T2, negative ganglia, without lymphovascular invasion and at localized stages (p < 0.05). Patients achieving at least disease stabilization had 1.8 times more survival possibilities than those who progressed (p = 0.001).
Conclusions: Patients with muscle-invasive bladder cancer treated with chemotherapy achieve slightly lower survival than reported internationally.
Key words: bladder cancer, treatment, chemotherapy, survival.
Downloads
References
1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. DOI: http://dx.doi.org/10.3322/caac.21492.
2. Sung H, Ferlay J, Siegel RL, Laverssane M, Soerjomataram I, Jemal A, Bray F. Globaal cancer statistics 2020: GLOBOCAN Estimate of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49. DOI: http://dx.doi.org/10.3322/caac.21660.
3. Globocan 2020: Estimated cancer incidence, mortality and prevalence worldwide in 2020 [último acceso 19 May 2021]. Disponible en: http://globocan.iarc.fr
4. Galán Y, Iglesias Y, Kindelan G, Planas S, Fernandez LM. Incidencia de cáncer en Cuba en el 2016. Rev Cub Oncol. 2020;18(3):e_46. Disponible en: http://revoncologia.sld.cu/index.php/onc/article/view/46/36
5. Anuario Estadístico de Salud 2019. Dirección de Registros Médicos y Estadísticas de Salud. MINSAP, La Habana; 2020. Disponible en: http://bvscuba.sld.cu/anuario-estadistico-de-salud-cuba/
6. Lenis AT, Lec PM, Chamie K, Mshs MD. Bladder cancer: a review. JAMA. 2020;324(19):1980-91. DOI: http://dx.doi.org/10.1001/jama.2020.17598.
7. Martinez Rodriguez RH, Buisan Rueda O, Ibarz L. Bladder cancer: present and future. Med Clin (Barc). 2017;149(10):449-455. DOI: http://dx.doi.org/10.1016/j.medcli.2017.06.009
8. Patel VG, Oh WK, Galsky MD. Treatment of muscle-invasive and advanced bladder cancer in 2020. CA Cancer J Clin. 2020;70(5):404-423. DOI: http://dx.doi.org/10.3322/caac.21631
9. Daneshmand S, Nazemi A. Neoadjuvant chemotherapy in variant histology bladder cancer: current evidence. Eur Urol Focus. 2020;6(4):639-41. DOI: http://dx.doi.org/10.1016/j.euf.2020.04.011
10. Viswambaram P, Hayne D. Gender discrepancies in bladder cancer: potential explanations. Exp Rev Anticancer Therap. 2020;20(10):841-49. DOI: https://doi.org/10.1080/14737140.2020.1813029
11. Magers MJ, Lopez Beltran A, Montironi R, Williamson RS, Kaimakliotis HZ, Cheng L. Staging of bladder cancer. Histopathology. 2019;74(1):112-134. DOI: http://dx.doi.org/10.1111/his/13734.
12. Soo M, Chang IH. Significance of age and comorbidity as prognostic indicators for patients with bladder cancer. Asian J Androl. 2010;12(6):766-774. DOI: http://dx.doi.org/10.1038/aja.2010.29
13. Monzo JI, Herranz F, Diex JM, Cabello R, Silmi A, Hernandez C. Factores pronósticos en la supervivencia de los pacientes con carcinoma transicional de vejiga tratados con cistectomía radical. Act Urol Esp. 2009;33(3):249-257. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_abstract^pid=S0210-48061009000300007
14. Del Pozo Jiménez G, Herranz Amo F, Diez JM, Mozo Gardiner J, Lledo García E, Subirá Ríos D, Carballido Rodríguez J, Hernández Fernández C. Factores pronósticos de mortalidad en pacientes con tumor urotelial de vejiga tratados con cistectomía radical. Arch Esp Urol. 2019; 72(5): 451-462. Disponible en: https://aeurologia.com/article_detail.php?aid=9d807570c0999b30e432448986122737fca1530b
15. Mir MC, Marchioni M, Zargar H, Zargar-Shoshtari K, Fairey AS, Mertens LS, et al. Nomogram predicting bladder cancer-specific mortality after neoadjuvant chemotherapy and radical cystectomy for muscle-invasive bladder cancer: results of an International Consortium. Eur Urol Focus. 2020:S2405-4569(20)30208-X. DOI:10.1016/j.euf.2020.07.002.
16. Cha EK, Stakianos JP, Sukhu R, Yee AM, Sjoberg DD, Bocher BH. Poor prognosis of bladder cáncer patients with occult lymph node metastases treated with neoadjuvant chemotherapy. BJU Int. 2018;122:627-632. DOI: https://doi.org/10.1016/j.euf.2020.07.002.
17. Hernández-Fernández Herranz Amo F, Moralejo Garate M, Subira Rios D, Velasco Cano J, Barbas Mernandos G. Cáncer vesical infiltrante: factores pronósticos, seguimiento y tratamiento de las recidivas. Actas Urol Esp. 2016;41(6):352-58. DOI: http://dx.doi.org/10.1016/j.acuro.2016.07.006
18. Youssef RF, Lotan Y. Predictor of outcome of non-muscle-invasive and muscle-invasive bladder cancer. Sci World J. 2011;11(2):369-381. DOI: http://dx.doi.org/10.1100/tsw.2011.28.
19. Kim H, Kim M, Kwak C, Kim HH, Ku JH. Prognostic significance of
lymphovascular invasion in radical cystectomy on patients with bladder cancer: a systematic review and meta-analysis. PLoS One. 2014;9(2):e89259. DOI: http://dx.doi.org/10.1371/journal.pone.0089259.
20. Schubert T, Todenhöfer T, Mischinger J, Schwentner C, Renninger M, Stenzl A, et al. The prognostic role of pre-cystectomy hemoglobin levels in patients with invasive bladder cancer. World J Urol. 2016;34(3):829-34. DOI:http://dx.doi.org/10.1007/s00345-015-1693-2.
21. Wang Y-L, Jiang B, Yin F-F, Shi H-Q, Xu X-D, Zheng S-S, et al. Perioperative blood transfusion promotes worse outcomes of bladder cancer after radical cystectomy: a systematic review and meta-analysis. PLoS ONE. 2015;10:e0130122. DOI: http://dx.doi.org/10.1371/journal.pone.0130122.
22. Ferrán Carpintero A, Domínguez García A, Muñoz Rodríguez J, Barquero López M, Prera A, Bonfill T, et al. Impact of anemia on the survival of patients undergoing radical cystectomy for bladder cancer. Actas Urol Esp. 2020;44(7):489-96. DOI: http://dx.doi.org/10.1016/j.acuro.2020.04.005.
23. Zhu Z, Zhao J, Li Y, Pang C, Zhu Z, Zhang X. Prognostic value of preoperative hydronephrosis in patients with bladder cancer undergoing radical cystectomy: a meta-analysis. PloS One. 2019;14(9):e0222223. DOI: https://doi.org/10.1371/journal.pone.0222223.
24. Zhang L, Wu B, Zha Z, Qu W, Zhao H, Yuan J. Clinicopathological factors in bladder cancer for cancer-specific survival outcomes following radical cystectomy: a systematic review and meta-analysis. BMC Cancer. 2019;19(1):716. DOI: https://doi.org/10,1186/s12885-019-5924-6.
25. Leow JJ, Martin-Doyle W, Rajagopal PS, Patel CG, Anderson EM, Rothman AT, Cote RJ, et al. Adjuvant chemotherapy for invasive bladder cancer: a 2013 updated systematic review and meta-analysis of randomized trials. Eur Urol. 2014;66(1):42-54. DOI: http://dx.doi.org/10.1016/j.eururo.2013.08.033
26. Achkar T, Parikh RA. Adjuvant therapy in muscle-invasive bladder cancer and upper tract urothelial carcinoma. Urol Clin N Am. 2018;45(2):257-266. DOI: https://doi.org/10.1016/j.ucl.2017.12.010
27. Kim DK, Lee JY, Jung JH, Hah YS, Cho KS. Role of adjuvant cisplatin-based chemotherapy after radical cystectomy in locally advanced muscle-invasive bladder cancer: systematic review and meta-analysis of randomized trials. Investig Clin Urol. 2019; 60(1):64-74. DOI: https://doi.org/10.4111/icu.2019.60.2.64
28. Horwich A, Babjuk M, Bellmunt J, Brunis HM, De Reijke TM, De Santis M, et al. EAU-ESMO consensus statements on the management of advanced and variant bladder cancer – an international collaborative multi-stakeholder effort: under auspices of EAU and ESMO Guidelines Comittees. Ann Oncol. 2019;30(Suppl 2):1697-1727.
DOI: http://dx.doi.org/10.1093/annonc/mdz296
29. Flaig TW, Spiess PE, Agarwal N, Bangs R, Boorjian SA, Buyyounouski MK, et al. NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer. Version 2.2021. Disponible en: www.nccn.org
30. Daneshmand S, Nazemi A. Neoadjuvant chemotherapy in variant histology bladder cancer: current evidence. Eur Urol Focus. 2020;6(4):639-641. DOI:https://doi.org/10.1016/j.euf.2020.04.011.
31. Jain RK, Sonpavde G. Neoadjuvant therapy for muscle-invasive bladder cancer. Expert Rev Anticancer Ther. 2020;20(7):603-614. DOI:https://doi.org/10.1018/14737140.2020.1784011.
32. Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. New Engl J Med. 2003;349(9):859-66. DOI:http://dx.doi.org/10.1056/NEJMoa022148.
33. International Collaboration of Trialists; Medical Research Council Advanced Bladder Cáncer Working Party (now the National Cancer Research Institute Bladder Cancer Clinical Studies Group); European Organization for Research and Treatment of Cancer Genito-Urinary Tract Cancer Group. International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: Long-term results of the BA06 30894 trial. J Clin Oncol. 2011;29(16): 2171–2177. DOI:http://dx.doi.org/10.1200/JCO.2010.32.3139.
34. Ge P, Wang L, Lu M, Mao L, Li W, Wen R, et al. Oncological outcome of primary and secondary muscle invasive bladder cancer: a systematic review and meta-analysis. Scient Rep. 2018;8(14):7543. DOI: http://dx.doi.org/10.1038/s41598-018-26002-6.
35. Yin M, Joshi M, Meijer RP, Glantz M, Holder S, Harvey HA, et al. Neoadjuvant chemotherapy for muscle-invasive bladder cancer: a systemic review and two-step meta-analysis. Oncologist. 2016;21(1):1-8. DOI: http://dx.doi.org/10.1634/theoncologist.2015-0440.
36. Zaghloul MS, Awwad HK, Akoush HH, Omar S, Soliman O, Al Attar. Postoperative radiotherapy of carcinoma in bilharzial bladder: improved disease free survival through improving local control. Int J Radiat Oncol Biol Phys. 1992;23(3):511-517. DOI:http://dx.doi.org/10.1016/0360-3016(92)90005-3.
37. Zaghloul MS, Christodouleas JP, Smith A, Abdallah A, William H, Khaled HM, et al. Adjuvant sandwich chemotherapy plus radiotherapy vs adjuvant chemotherapy alone for locally advanced bladder cancer after radical cystectomy. JAMA Surgery. 2018;153(1):e174591. DOI: http://dx.doi.org/10.1001/jamasurg.2017.4591.
38. Iwata T, Kimura S, Abufaraj, Janisch F, Karakiewicz PI, Seebacher V, et al. The role of adjuvant radiotherapy after surgery for upper and lower urinary tract urothelial carcinoma: a systematic review. Urol Oncol. 2019;37(10):659-671. DOI: http://dx.doi.org/10.1016/j.urolonc.2019.05.021.
Downloads
Published
How to Cite
Issue
Section
License
Esta revista provee acceso libre e inmediato a su contenido bajo el principio de que hacer disponible gratuitamente la investigación al público apoya a un mayor intercambio de conocimiento global.
Esto significa que se permite su copia y distribución por cualquier medio siempre que mantenga el reconocimiento de sus autores, no haga uso comercial de las obras y no realice ninguna modificación de ellas.
El envío de manuscritos, el procesamiento y la publicación no ofrece ningún coste a los autores, es totalmente gratis.
