Factors Associated With Locoregional Recurrence in Muscle-Invasive Bladder Cancer

Locoregional recurrence (LRR) is a common but well understood challenge among some patients with nonmetastatic muscle invasive cancer (MIBC), and strategic administration of adjuvant therapies may lead to improved outcomes, according to study published in Cancer Treatment Reviews.¹

Radical cystectomy is the most widely used local therapy for nonmetastatic MIBC, but LRR remains a significant challenge to manage. A better understanding of the factors associated with LRR and focused adjuvant therapeutic strategies may lead to enhanced oncologic outcomes in this patient population.

For this systematic review, researchers evaluated data from 32 studies that assessed the outcomes of patients with MIBC. The authors assessed the type of surgery and pelvic lymph-node dissection (PLND) patients had received, whether patients received neo-adjuvant or adjuvant chemotherapy, their LRR rates, and prognostic factors linked to the individuals.

Results showed that LRR is associated with various specific patient-, tumor-, center-, and treatment-related factors, and also has a strong link to survival outcomes. The LRR rate differed widely among the studies with an occurrence rate as high as 43% in patients. 

Advanced age, responsiveness to chemotherapy, lower pathologic tumor stage, less lymph node invasion, extended PLND, lower number of removed lymph nodes and lymph node density, negative surgical margins, and treatment at academic institutions or high-volume institutions, were significantly associated with improved LRR. Study authors examined the use of perioperative chemotherapy as well as qualitative surgical approaches when determining the framework for adjuvant radiotherapy. The review showed that locoregional control was directly associated with a benefit in overall survival (OS) and that post-cystectomy LRR was “highly detrimental to prognosis and rarely salvageable.”

Multiple randomized trial and meta-analyses further demonstrated a benefit in OS for localized MIBC among patients who received adjuvant chemotherapy and cystectomy associated with PLND; the response to neoadjuvant chemotherapy, however, appeared to be dependent on the intrinsic bladder cancer subtype. Specifically, Seiler and colleagues showed that clinical benefit with cisplatin-based neoadjuvant chemotherapy was lower in patients with non-basal tumors.²

Based on the findings, the authors concluded that “future efforts should focus on adjuvant radiotherapy in combination with immunotherapy and chemotherapy, maybe in a synergistic or sequential schedule, with a personalized patient and tumor strategy.”

References

1. Sargos P, Baumann BC, Eapen L, et al. Risk factors for loco-regional recurrence after radical cystectomy of muscle-invasive bladder cancer: A systematic-review and framework for adjuvant radiotherapy [published online July 19, 2018]. Cancer Treat Rev. doi: 10.1016/j.ctrv.2018.07.011
2. Seiler R, Ashab HAD, Erho N, et al. Impact of molecular Subtypes in muscle-invasive bladder cancer on predicting response and survival after neoadjuvant chemotherapy. Eur Urol. 2017;72(4):544-554.