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Ureteral Obstruction Prior to Chemotherapy for Muscle-Invasive Bladder Cancer

By: Julia Fiederlein
Posted: Friday, January 8, 2021

Matthew Epstein, MD, of Temple University, Philadelphia, and colleagues conducted a retrospective analysis to determine whether patients with muscle-invasive bladder cancer may benefit from the relief of ureteral obstruction before neoadjuvant cisplatin-based chemotherapy. The results of this retrospective analysis, which were presented during the virtual edition of the 2020 Society of Urologic Oncology (SUO) Annual Meeting (Abstract 12), suggested that eligible patients may be able to avoid this invasive procedure safely.

The investigators focused on 280 patients with hydronephrosis who underwent neoadjuvant cisplatin-based chemotherapy. Patients with ureteral obstruction were stratified into relieved (n = 48) and unrelieved (n = 37) obstruction groups based on whether a percutaneous nephrostomy tube or nephroureteral stent was placed in the obstructed kidney before treatment.

Baseline characteristics and outcome measures did not seem to significantly differ between the groups. Results of the multivariate analysis did not reveal significant differences in the rates of premature neoadjuvant cisplatin-based chemotherapy discontinuation (P = .88), adverse events of grade 3 or higher (P = .87), or change in the glomerular filtration rate (P = .52) between the groups.

According to the investigators, 14 and 19 patients with unrelieved obstruction had sufficient hydronephrosis to be included in the first and second sensitivity analyses, respectively. Based on the multivariate analysis, the rates of premature neoadjuvant cisplatin-based chemotherapy discontinuation, adverse events of grade 3 or higher, and change in the glomerular filtration rate did not seem to significantly differ between the relieved and unrelieved obstruction groups in the first (P = .87, .64, and .26, respectively) and second (P = .44, .86, and .24, respectively) sensitivity analyses.

Disclosure: No information regarding conflicts of interest was provided.



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