Tumor Regression after Neoadjuvant Chemotherapy Independently Predicts Survival in Bladder Cancer Patients
Achim Fleischmann, Aurel Perren, George N Thalmann, Roland Seiler. University of Bern, Bern, Switzerland
Background: Tumor regression after chemotherapy predicts survival in different cancers. In bladder cancer these studies are still missing.
Design: A cohort of 59 patients with histopatholgically proven urothelial bladder cancer received neoadjuvant chemotherapy (median 4 cycles) before cystectomy and lymphadenectomy. Indications were clinically positive lymph nodes (n=41), advanced primary tumour stage cT4 (n=15) and other reasons (n=3). A tumor regression grade (TRG) was defined similar to the method proposed by Mandard et al. (Cancer 1994;71:2680-6) for esophageal cancer. TRG 1: complete regression without residual cancer and with extensive fibrosis of the tumor bed; TRG 2: presence of residual cancer cells scattered through the predominating fibrosis; TRG 3: residual cancer outgrowing fibrosis or absence of regression. Histopathological characteristics of the untreated tumors (growth patterns, histological subtypes, nuclear size, peri- and intratumoural inflammation, mitotic rate) were correlated with TRG and different parameters of the treated tumors were tested for overall survival (OS) stratification.
Results: Seventeen patients each (28%) had TRG 1 and TRG 2, 25 patients (44%) TRG 3. In the untreated cancers, the only parameter with significant (p<0.05) predictive value for therapy response was a high mitotic rate. Higher TRG grades were significantly (p<0.05) associated with unfavorable characteristics in surgical specimens (higher ypT and ypN stage, number of positive blocks and diameter of residual tumor). In univariate analysis, TRG, ypT, number of blocks with residual tumor tissue, largest diameter of primary tumor and ypN stratified OS significantly. In multivariate analysis, only TRG predicted OS independently (p<0.05).
Conclusions: The suggested tumor regression grade in bladder cancer is an independent predictor of survival. A favorable chemotherapy response is associated with a high mitotic rate in the untreated tumor. This parameter might help to identify patients which benefit from neoadjuvant chemotherapy.
Category: Genitourinary (including renal tumors)
Monday, March 19, 2012 1:45 PM
Platform Session: Section A, Monday Afternoon