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Master Thesis

Chimiothérapie néoadjuvante et chirurgie dans la prise en charge des cancers de vessie infiltrants : caractéristiques, pronostic oncologique et complications péri-opératoires

Abstract : Introduction: Muscle-invasive bladder cancer (MIBC) is a severe disease with a 5-year overall survival (OS) around 50%. The patients are often elderly or frail. The standard of care remains neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). The global complications rate stands around 60% with a post-operative mortality between 2 and 7%. In this study, we aimed to evaluate the pre-operative assessment of patients, to find prognostic factors for morbidity and to assess the role of NAC on 5-year survival outcomes. Methods: The data of all patients treated by RC for MIBC in Grenoble University Hospital, France between January 2010 and December 2019 were collected. NAC was considered in case of eligibility. Demographic parameters and medical history were used to calculate ASA score, Charlson Comorbidities Index (CCI) and POSPOM score. An analysis of post-operative mortality and complications according to Clavien-Dindo Classification (CDC) was performed, using logistic regression and ROC curves. Survival data and pathological response (complete (cPR) or partial (pPR)) with and without NAC were compared using uni and multivariate regression models and Kaplan-Meier curves. Results: 167 patients were included. Median age was 70. Median CCI was 6, and median POSPOM estimated mortality was 5,6%. Severe complications (CDC≥3) and 90-day mortality occurred in respectively 26% and 8,4%. Higher prognostic-scores were significantly associated with CDC≥3 (CCI: median 5 vs 6.5, p<0.01; POSPOM: median 5,6% vs 6,5%, p=0.029; ASA >2 (p<0,01)) and death (CCI >5 (p<0,01), ASA >2 (p<0,01), POSPOM ≥5% (p<0,01), ECOG-PS ≥1 (p=0,012)). POSPOM score ROC curve predicted death with an AUC of 0,887, with a trend of better precision without reaching significance. 28% of the cohort received NAC. Tumors were more locally advanced in this group (cT3-4: 60% vs 41%, p=0,18; cN+ = 24% vs 15%, p=0,14). cPR occurred in 24% for the NAC+RC group, against 7% for RC alone group. 5-year OS, CSS and RFS did not differ between CAN+CR and control group (OS: 39,4% vs 32,9%, p=0,075; CSS: 60,4% vs 59,1%, p=0,65; RFS: 52,2% vs 46,1%, p=0,77). In multivariate analysis, female sex (p=0,031), T3 and T4 clinical stage (p=0,031) and CCI>5 (p=0,044) were associated with decreased OS. Conclusion: The high morbidity of cystectomy is influenced by patients' comorbidities. POSPOM score in one of the best predictors of postoperative mortality and should be calculated before surgery. Despite a significant pathological response rate, NAC did not improve survival in our cohort. We suggest the stronger impact of disease stage and patient comorbidities on survival. However, further larger studies are required to confirm our data.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03402727
Contributor : Jean-Hugues Morneau Connect in order to contact the contributor
Submitted on : Tuesday, October 26, 2021 - 10:02:12 AM
Last modification on : Thursday, October 28, 2021 - 3:43:09 AM

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  • HAL Id : dumas-03402727, version 1

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Mathieu Blachier. Chimiothérapie néoadjuvante et chirurgie dans la prise en charge des cancers de vessie infiltrants : caractéristiques, pronostic oncologique et complications péri-opératoires. Médecine humaine et pathologie. 2021. ⟨dumas-03402727⟩

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