Control computerized tomography in neoadjuvant chemotherapy for muscle invasive urinary bladder cancer has no value for treatment decisions and low correlation with nodal status

Abstract

Background

Control computerized tomography (cCT) is routinely used in many cystectomy centres before the final treatment cycle in patients with muscle-invasive urinary bladder cancer (MIBC) undergoing neoadjuvant chemotherapy (NAC). This is for evaluating response or nonresponse to NAC treatment. In a real-world retrospective cohort, we intended to evaluate the frequency of changed individual treatment strategies following cCT and to investigate any discrepancies between cCT-results on nodal staging and final pN-stages.

Methods

We performed a retrospective data-based, multicenter study of 242 MIBC-patients, staged cT2N0M0-cT4aN0M0, having undergone NAC and radical cystectomy (RC) between 2008 and 2019 at four Swedish cystectomy centres. Statistical analysis was performed using IBM SPSS statistics 26.

Results

Overall, 139/242 patients were examined with cCT. Six patients were staged as progressive at cCT and 5/139 (3.6%) underwent a change of previously planned treatment strategy. 2/6 patients with suspected progression (33%) did not change strategy and underwent all preplanned NAC-cycles plus RC. Only 1/6 patients assigned as progressive at the cCT, showed progression in the postoperative pathology specimen. In total 133/139 patients were considered being without progress on cCT, yet 28/133 (21%) presented with nodal progression at postoperative pathology examinations. Only 1/29 patients with histopathologically verified nodal dissemination were detected with cCT, thus 28/29 (96.6%) with pN + were undetected. The sensitivity for cCT to predict pTNM was 17% CI [0%–64%] and the specificity was 78% CI [71%–86%].

Conclusions

CCT prior to the final treatment cycle of NAC in MIBC, leads to a low percentage of treatment strategy changes and cCT cannot accurately predict pN-status.

Keywords:

• Computed X-ray tomography
• cystectomy
• interdisciplinary health team
• neoadjuvant therapy
• urinary bladder neoplasms

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data Availability statement

On reasonable request, the corresponding author can make available all codified data from the data base used for this study.

Additional information

Funding

This work was supported by the Swedish Research Council funding for clinical research in medicine (ALF) in Västerbotten, VLL (Grant No. Bas-ALF/VLL RV-848051), Sweden and the Cancer Research Foundation in Norrland, Umeå, Sweden (Grant No. CFF LP 13-2000).