Quimiohipertermia endovesical recirculante en el tratamiento del càncer vesical no músculo invasivo

Abstract

Introduction: Different articles have shown that the proportion of neutrophils to lymphocytes (Neutrofile-to-Lymphocyte Ratio: NLR) and the proportion of platelets to lymphocytes (Platelet-to-Lymphocyte Ratio: PLR) can predict survival in different cancers including invasive bladder cancer (CVMI). Objective: To determine whether NLR and PLR can predict pathological response and recurrence-free survival in non-invasive bladder cancer (NMIBC) treated with intravesical neoadjuvant hyperthermic chemotherapy (Hyperthermic Intravesical chemotherapy: HIVEC). Patients and methods: We conducted an observational, analytical and retrospective cohort study of 43 patients with upper-intermediate risk NMIBC treated with neoadjuvant HIVEC between January 2009 and June 2017 in a single institution. The neoadjuvant treatment comprises eight weekly instillations of HIVEC using the Combat BRS device (London, United Kingdom) with 80 mg of mitomycin-C (MMC) in 50 ml of water for 1 hour. All patients had transurethral bladder resection (TURB) 2 weeks after treatment with HIVEC. The primary objective was to determine the complete response rate (CR) obtained in post-treatment TURV and disease-free survival (SLE) at 12 months. NLR and PLR were measured before and after treatment with neoadjuvant HIVEC Results: After neoadjuvant treatment with HIVEC, 27 (63%) patients had CR and 13 (30%) patients had a partial response (PR) in TURP. The median follow-up after TURP was 51 months (Interquartile Range (RIC): 12.9-108.0 months) with an SLE of 81.4% without the patients developing progression. Post-HIVEC reduction in PLR and NLR (before and after treatment) was predictive of CR. A lower post-HIVEC NLR and a fall in PLR and NLR after treatment with HIVEC were associated with a higher SLE. Conclusions: The treatment with HIVEC Neoadjuvant resulted in a CR rate of 62.8%. A reduction in NLR and PLR was associated with an improvement in response to treatment in both the CR and SLE index. In addition, CR was associated with a durable SLE in 89% of patients.