Evaluating the Survival Benefits of Perioperative Chemotherapy in Frail and Morbid Muscle-Invasive Bladder Cancer Patients †

Ziv Savin*, Lin Levin, Alon Lazarovich, Barak Rosenzweig, Reut Shashar, Azik Hoffman, Jonathan Gal, Miki Haifler, Ilona Pilosov, Yuval Freifeld, Sagi Arieh Shpitzer, Shay Golan, Roy Mano, Ofer Yossepowitch

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Current guidelines endorse the use of perioperative chemotherapy (POC) in muscle-invasive bladder cancer (MIBC) to enhance the long-term overall survival (OS) compared to radical cystectomy (RC) alone. This study aims to assess the impact of POC on the OS in frail and morbid (F-M) patients undergoing RC. Methods: A retrospective multicenter study of 291 patients who underwent RC between 2015 and 2019 was performed. Patients with both a Charlson comorbidity index ≥ 4 and Modified Frailty Index ≥ 2 were classified as the F-M cohort. We compared the clinical and pathological characteristics and outcomes of the F-M patients who received POC to those who underwent RC alone. Univariable and multivariable analyses were performed to identify the predictors of the OS. Results: The F-M cohort included 102 patients. POC was administered to 44% of these patients: neoadjuvant (NAC) to 31%, adjuvant (AC) to 19%, and both to 6 (6%). The OS was significantly lower in the F-M cohort compared to in the healthier patients (median OS 42 months, p = 0.02). The F-M patients who received POC were younger, less morbid and had better renal function. Although POC was marginally associated with improved OS in the univariable analysis (p = 0.06), this was not significant in the multivariable analysis (p = 0.50). NAC was associated with improved OS in the univariable analysis (p = 0.004) but not after adjustment for competing factors (p = 1.00). AC was not associated with the OS. Conclusions: POC does not improve the OS in F-M patients undergoing RC. Personalized treatment strategies and further prospective studies are needed to optimize care in this unique vulnerable population.

Original languageEnglish
Article number954
JournalJournal of Personalized Medicine
Volume14
Issue number9
DOIs
StatePublished - Sep 2024

Keywords

  • adjuvant chemotherapy
  • bladder cancer
  • comorbidity index
  • frailty
  • neoadjuvant chemotherapy

Fingerprint

Dive into the research topics of 'Evaluating the Survival Benefits of Perioperative Chemotherapy in Frail and Morbid Muscle-Invasive Bladder Cancer Patients †'. Together they form a unique fingerprint.

Cite this