Page 17 - JCTR-9-6

Journal of Clinical and Translational Research 2023; 9(6): 381-391

Journal of Clinical and Translational Research

Journal homepage: http://www.jctres.com/en/home

ORIGINAL ARTICLE

Association between response to neoadjuvant chemotherapy and survival

outcome after radical surgery in patients with yielding pathological
T2≤ and/or N+ urothelial carcinoma

Makito Miyake *, Nobutaka Nishimura , Nagaaki Marugami , Tomomi Fujii , Yuya Fujiwara , Kazumasa Komura ,
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Teruo Inamoto , Haruhito Azuma , Hiroaki Matsumoto , Hideyasu Matsuyama , Kiyohide Fujimoto , on behalf of Nishinihon
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Uro-Oncology Collaborative Group
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1 Department of Urology, Nara Medical University, Kashihara, Nara, 634-8522, Japan, Department of Radiology, Nara Medical University,
Kashihara, Nara, Japan, Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, 634-8522, Japan, Department of Urology,
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Osaka Medical and Pharmaceutical University, Takatsuki, Japan, Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube,
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Yamaguchi, Japan, Department of Urology, JA Yamaguchi Kouseiren Nagato General Hospital, Yamaguchi, Japan
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ARTICLE INFO ABSTRACT
Article history: Background and Aim: In early 2022, the use of adjuvant nivolumab for patients with high-risk muscle-
Received: August 26, 2023 invasive urothelial carcinoma (MIUC) was approved in Japan, European countries, and USA based
Revised: October 10, 2023 on the positive results of CheckMate 274 trial, which included participants who received neoadjuvant
Accepted: October 11, 2023 chemotherapy (NAC). Subgroup analyses of CheckMate 274 trial do not report response to NAC and
Published online: November 12, 2023 benefit from adjuvant nivolumab. Herein, we investigated the association between response to NAC
and survival outcomes after radical surgery in patients with residual MIUC and/or lymph node disease.
Keywords Methods: This multicenter retrospective study included a total of 95 NAC-treated patients with
Bladder cancer yielding pathological (yp) T2≤ and/or ypN+ UC on radical surgery specimens. Based on the
Upper urinary tract cancer comparison of clinical T and N category with yp T and N category, the patients were categorized
Radical surgery into three groups: Down-staged ypT2≤ (n = 14), no-changed ypT2≤ (n = 39), and up-staged ypT2 ≤
Nivolumab groups (n = 42).
Neoadjuvant Results: There was no significant difference in extraurinary tract recurrence-free survival, cancer-
Response specific survival, and overall survival after the radical surgery among three groups. Subgroup analysis
of a bladder cancer cohort showed a marginal association between better response and longer cancer-
*Corresponding author: specific survival (P = 0.073).
Makito Miyake Conclusion: Our finding suggested that adjuvant nivolumab should be considered for all the patients
Department of Urology, Nara Medical with pathological ypT2≤ or ypN+ UC regardless of response to NAC. Further research is mandatory
University, 840 Shijo-cho, Nara 634-8522, in finding predictive factors that serve in decision-making for NAC-treated patients who are likely to
Japan. benefit from adjuvant nivolumab.
Tel: +81-744-22-3051 (ext 2338) Relevance for Patients: To develop a decision-making tool for adjuvant nivolumab, we investigated
Fax: +81-744-22-9282 the association between response to NAC and survival after radical surgery. Further research is
E-mail: makitomiyake@yahoo.co.jp
mandatory in finding predictive factors that serve in decision-making for NAC-treated patients who
are likely to benefit from adjuvant nivolumab.
© 2023 Author(s). This is an Open-Access
article distributed under the terms of the
Creative Commons Attribution-Noncommercial
License, permitting all non-commercial use, 1. Introduction
distribution, and reproduction in any medium,
provided the original work is properly cited. Urothelial carcinoma (UC) arises from the urinary tract mucosa in the renal pelvis,
ureters, bladder, or urethra. Particularly, muscle-invasive UC (MIUC) is aggressive and
associated with a poor clinical outcome, requiring multidisciplinary management. Radical
nephroureterectomy (RNU) with bladder cuff remains the standard care for localized upper
DOI: http://dx.doi.org/10.18053/jctres.09.202306.23-00106