Comparative Effectiveness Analysis of Treatment Strategies for Surgically Resectable Neuroendocrine Carcinoma of the Urinary Tract.
Eur Urol Oncol
; 6(6): 611-620, 2023 12.
Article
em En
| MEDLINE
| ID: mdl-37833193
ABSTRACT
BACKGROUND:
Neoadjuvant chemotherapy (neoCTX) has been recommended as the optimal strategy in surgically resectable neuroendocrine carcinoma (NEC) of the urinary tract (NEC-URO).OBJECTIVE:
To determine the systemic therapy regimen and timing, which are most active against NEC-URO. DESIGN, SETTING, ANDPARTICIPANTS:
We used our institutional historical clinical and pathological database to study 203 patients (cT2, 74%; cT3/4a, 22%; and cTx, 4%) with surgically resectable NEC-URO between November 1985 and May 2020. A total of 141 patients received neoCTX and 62 underwent initial radical surgery, 24 of whom received adjuvant CTX (adjCTX). INTERVENTION Neoadjuvant CTX with etoposide/cisplatin (EP), an alternating doublet of ifosfamide/doxorubicin (IA) and EP, dose-dense methotrexate/vinblastine/doxorubicin/cisplatin (MVAC), gemcitabine/cisplatin (GC), or others. OUTCOME MEASUREMENTS AND STATISTICALANALYSIS:
Overall survival (OS), downstaging rate, and pathological complete response using a multivariable model adjusting for tumor- and patient-related factors. RESULTS ANDLIMITATIONS:
Downstaging rate was significantly improved with neoCTX versus initial surgery (49.6% vs 14.5%, pâ¯<â¯0.0001), stage cT2N0 versus cT3/4N0 (44% vs 25%, pâ¯=â¯0.01), or presence of carcinoma in situ (47% vs 28%, pâ¯=â¯0.01). Downstaging was greatest with IA/EP (65%) versus EP (39%), MVAC/GC (27%), or others (36%, pâ¯=â¯0.04). After adjusting for age and Eastern Cooperative Oncology Group performance status, IA/EP was still associated with improved downstaging (odds ratioâ¯=â¯3.7 [1.3-10.2], pâ¯=â¯0.01). At a median follow-up of 59.7 mo, 5-yr OS rates for neoCTX followed by surgery, surgery alone, and surgery followed by adjCTX were 57%, 22%, and 30%, respectively. An NEC regimen (IA/EP or EP) versus a urothelial regimen (MVAC/GC or others) was associated with improved survival (145.4 vs 42.5 mo, hazard ratioâ¯=â¯0.49, 95% confidence interval 0.25-0.94).CONCLUSIONS:
Neoadjuvant CTX remains the standard-of-care treatment for NEC-URO with an advantage for NEC regimens over traditional urothelial regimens. IA/EP improves pathological downstaging at the time of surgery compared with EP, but is reserved for younger and higher function patients. PATIENTSUMMARY:
In this report, we looked at the outcomes from invasive neuroendocrine carcinoma of the urinary tract in a large US population. We found that the outcomes varied with treatment strategy. We conclude that the best outcomes are seen in patients treated with chemotherapy prior to surgery and regimens tailored to histology and tolerance.Palavras-chave
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Sistema Urinário
/
Neoplasias da Bexiga Urinária
/
Carcinoma Neuroendócrino
Limite:
Humans
Idioma:
En
Revista:
Eur Urol Oncol
Ano de publicação:
2023
Tipo de documento:
Article