PMID- 38238116
OWN - NLM
STAT- MEDLINE
DCOM- 20240325
LR  - 20240411
IS  - 1873-2496 (Electronic)
IS  - 1078-1439 (Linking)
VI  - 42
IP  - 4
DP  - 2024 Apr
TI  - Longer time to radical cystectomy in patients treated with neoadjuvant 
      chemotherapy is associated with worse oncological outcomes.
PG  - 117.e11-117.e16
LID - S1078-1439(23)00511-2 [pii]
LID - 10.1016/j.urolonc.2023.12.014 [doi]
AB  - BACKGROUND: Current muscle-invasive bladder cancer (MIBC) guidelines recommend 
      not delaying radical cystectomy (RC) >3 months after diagnosis as it decreases 
      overall survival (OS). However, literature investigating the impact of delay in 
      RC in patients who receive NAC is limited, especially on a population-based 
      level. OBJECTIVE: To investigate the association between time from diagnosis of 
      MIBC to RC (TTRC) in patients with urothelial bladder cancer (UBC) treated with 
      NAC and RC and 1) 2-year OS and 2) pathological lymph node status (pN+) in a 
      population-based cohort. METHODS: Patients were selected from the Netherlands 
      Cancer Registry. The study included 237 patients with cT2-T4aN0M0 UBC, treated 
      with NAC and RC between November 2017 and October 2019. Association between TTRC 
      and OS was assessed using multivariable Cox regression analyses. Schoenfeld and 
      Martingale residuals were used to investigate the proportional hazards assumption 
      and whether a cut-off in the TTRC could be identified. Association between TTRC 
      and pN+ was assessed using multivariable logistic regression analyses. RESULTS: 
      Median TTRC was 23 weeks (interquartile range (IQR) 19-26). 2-year OS was 67% 
      (95%CI 59%-74%). Each week of delay in the TTRC was independently associated with 
      2-year OS (HR 1.06; P = 0.03) in the Cox regression analysis. The sensitivity 
      analyses, defining TTRC as the time between last cycle of NAC and RC, revealed 
      that each week of delay between NAC and RC was associated with 2-year OS (Hazard 
      ratio (HR) 1.13; P < 0.0001), and with pN+ (Odds ratio (OR) 1.21; P = 0.01) in 
      the Cox and logistic regression analyses, respectively. CONCLUSIONS: A longer 
      TTRC is associated with worse oncological outcomes in patients treated with NAC 
      and RC.
CI  - Copyright (c) 2024 The Author(s). Published by Elsevier Inc. All rights reserved.
FAU - Nuijens, Siberyn T
AU  - Nuijens ST
AD  - Department of Urology, Radboud University Medical Centre, Nijmegen, the 
      Netherlands; Department of Research and Development, Netherlands Comprehensive 
      Cancer Organisation, Utrecht, the Netherlands. Electronic address: 
      sieb.nuijens@radboudumc.nl.
FAU - van Osch, Frits H M
AU  - van Osch FHM
AD  - Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The 
      Netherlands; Department of Epidemiology, NUTRIM School for Nutrition and 
      Translational Research in Metabolism, Maastricht University, Maastricht, The 
      Netherlands.
FAU - van Hoogstraten, Lisa M C
AU  - van Hoogstraten LMC
AD  - Department of Urology, Radboud University Medical Centre, Nijmegen, the 
      Netherlands; Department of Research and Development, Netherlands Comprehensive 
      Cancer Organisation, Utrecht, the Netherlands; Department for Health Evidence, 
      Radboud University Medical Centre, Nijmegen, the Netherlands.
FAU - Witjes, J Alfred
AU  - Witjes JA
AD  - Department of Urology, Radboud University Medical Centre, Nijmegen, the 
      Netherlands.
FAU - Aben, Katja K H
AU  - Aben KKH
AD  - Department of Research and Development, Netherlands Comprehensive Cancer 
      Organisation, Utrecht, the Netherlands; Department for Health Evidence, Radboud 
      University Medical Centre, Nijmegen, the Netherlands.
FAU - Hermans, Tom J N
AU  - Hermans TJN
AD  - Department of Urology, VieCuri Medical Center, Venlo, the Netherlands; Department 
      of Urology, Maastricht University Medical Center, Maastricht, The Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20240117
PL  - United States
TA  - Urol Oncol
JT  - Urologic oncology
JID - 9805460
SB  - IM
MH  - Humans
MH  - Cystectomy
MH  - Neoadjuvant Therapy
MH  - Urinary Bladder/pathology
MH  - *Urinary Bladder Neoplasms/drug therapy/surgery/pathology
MH  - *Carcinoma, Transitional Cell/pathology
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Delay
OT  - Lymph node metastases
OT  - Neoadjuvant chemotherapy
OT  - Overall survival
OT  - Radical cystectomy
COIS- Declaration of competing interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2024/01/19 00:42
MHDA- 2024/03/25 06:42
CRDT- 2024/01/18 21:52
PHST- 2023/09/01 00:00 [received]
PHST- 2023/11/17 00:00 [revised]
PHST- 2023/12/24 00:00 [accepted]
PHST- 2024/03/25 06:42 [medline]
PHST- 2024/01/19 00:42 [pubmed]
PHST- 2024/01/18 21:52 [entrez]
AID - S1078-1439(23)00511-2 [pii]
AID - 10.1016/j.urolonc.2023.12.014 [doi]
PST - ppublish
SO  - Urol Oncol. 2024 Apr;42(4):117.e11-117.e16. doi: 10.1016/j.urolonc.2023.12.014. 
      Epub 2024 Jan 17.