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Asero V, Scornajenghi CM, Carino D, Pandolfo SD, Krajewski W, Gallioli A, Basran S, Tresh A, Chung BI, Del Giudice F. Comment on: "Stage-dependent survival in patients treated with neoadjuvant chemotherapy and radical cystectomy". Minerva Urol Nephrol 2023; 75:649-651. [PMID: 37530677 DOI: 10.23736/s2724-6051.23.05529-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Affiliation(s)
- Vincenzo Asero
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Carlo M Scornajenghi
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Dalila Carino
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Savio D Pandolfo
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Andrea Gallioli
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Satvir Basran
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Anas Tresh
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy -
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
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D'Andrea D, Shariat SF, Soria F, DI Trapani E, Mertens LS, VAN Rhijn BW, Dinney CP, Black PC, Spiess PE, Carrion DM, Pradere B, Tonin E, Pichler R, Filippot R, Mari A, Moschini M. Stage-dependent survival in patients treated with neoadjuvant chemotherapy and radical cystectomy. Minerva Urol Nephrol 2023; 75:452-459. [PMID: 37314813 DOI: 10.23736/s2724-6051.23.05289-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The aim of this study is to investigate the differential stage-dependent outcomes of patients undergoing radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC). METHODS We performed a retrospective analysis of 1422 patients with cT2-4N0 MIBC treated with RC, with/without cisplatin-based NAC, from our multicenter cooperation program (treated period: 1992-2021). Patients were stratified according to their pathologic stage at RC. Cancer-specific survival (CSS) and overall survival (OS) were calculated using mixed-effects Cox analysis. RESULTS Analysis was conducted on 761 patients treated with NAC followed by RC and 661 treated with RC only (median follow-up 19 months). Of 337 (24%) patients who died, 259 (18%) died of bladder cancer. On univariable analyses, increased pathologic stage was significantly associated with worse CSS (HR=1.59, 95% CI 1.46-1.73; P<0.01) and OS (HR=1.58, 95% CI 1.47-1.71; P<0.001). On multivariable mixed-effects model, patients after RC only had significantly worse CSS with stage pT≥3/N1-3 and OS with stage pT≥2/N0-3 compared to those with stage pT≤1N0. Patients after RC and NAC had significantly worse CSS and OS already at stage ypT≥2/N0-3 compared to those with ypT≤1N0. On subgroup analyses, CSS (HR=4.26; 95% CI 2.03-8.95; P<0.001) but not OS (HR=1.1; 95% CI 0.5-2.4; P=0.81) was worse for pT2N0 patients after NAC versus no-NAC. This difference was not maintained on multivariable analysis. CONCLUSIONS NAC improves pathologic stage at the time of RC. Patients with residual MIBC after NAC have worse survival outcomes compared to those with the same pathologic stage who did not receive NAC, suggesting a need for better adjuvant therapy in these patients.
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Affiliation(s)
- David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria -
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Francesco Soria
- Department of Urology, Molinette Hospital, University of Turin, Turin, Italy
| | - Ettore DI Trapani
- Department of Urology, European Institute of Oncology - IRCCS, Milan, Italy
| | - Laura S Mertens
- Department of Urology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Bas W VAN Rhijn
- Department of Urology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Colin P Dinney
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA
| | - Diego M Carrion
- Department of Urology, Torrejon University Hospital, Madrid, Spain
| | - Benjamin Pradere
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Croix Du Sud Hospital, Quint-Fonsegrives, France
| | - Elena Tonin
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Renate Pichler
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ronan Filippot
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Marco Moschini
- Department of Urology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Del Giudice F, Chung BI, Moschini M, Mari A, D'Andrea D, Soria F, Krajewski W, Gallioli A, DE Berardinis E, Maggi M. Comment on: Postoperative outcomes of Fast-Track-enhanced recovery protocol in open radical cystectomy: comparison with standard management in a high-volume center and Trifecta proposal. Minerva Urol Nephrol 2022; 74:119-121. [PMID: 35272453 DOI: 10.23736/s2724-6051.22.04872-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy - .,Stanford University School of Medicine, Department of Urology, Stanford, CA, USA -
| | - Benjamin I Chung
- Stanford University School of Medicine, Department of Urology, Stanford, CA, USA
| | - Marco Moschini
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Mari
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Andrea Gallioli
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Ettore DE Berardinis
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Martina Maggi
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
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Del Giudice F, D'Andrea D, Mari A, Soria F, Krajewski W, Moschini M. Is there enough evidence available nowadays to suggest a paradigmatic shift in treatment of MIBC with perioperative systemic therapy administration? Minerva Urol Nephrol 2021; 73:674-676. [PMID: 34847650 DOI: 10.23736/s2724-6051.21.04762-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy - .,Department of Urology, Stanford Medical Center, Stanford, CA, USA -
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Andrea Mari
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences and Urology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, University Center of Excellence in Urology, Wroclaw, Poland
| | - Marco Moschini
- Division of Experimental Oncology, Department of Urology, Urological Research Institute, Vita-Salute San Raffaele University, Milan, Italy
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