Chimiothérapie adjuvante à base de carboplatine versus observation après cystectomie radicale chez les patients atteints d'un cancer urothélial de la vessie pN1-3

Diplôme Thèse Chimiothérapie adjuvante à base de carboplatine versus observation après cystectomie radicale chez les patients atteints d'un cancer urothélial de la vessie pN1-3 fre eng 2023 2023 author Afferi Luca 0000-0002-5472-1933 968699 director Mattei Agostino 766071 Département de chirurgie (CHIRU) 31 10.13097/archive-ouverte/unige:169617 urn:nbn:ch:unige-1696175 Méd. 11162 Objective. To test the impact of carboplatin-based ACT on overall survival (OS) in patients with pN1-3 cM0 BCa. Methods. A retrospective analysis was conducted on 1057 patients with pTany pN1-3 cM0 urothelial BCa treated with or without carboplatin-based ACT after radical cystectomy and bilateral lymph-node dissection between 2002 and 2018 at 12 European and North-American hospitals. No patient received neoadjuvant chemotherapy or radiation therapy. Only patients with negative surgical margins at surgery were included. A 3:1 propensity score matching (PSM) was performed using logistic regression to adjust for baseline characteristics. Univariable and multivariable Cox regression analyses were used to predict the effect of carboplatin-based ACT on OS. The Kaplan–Meier method was used to display OS in the matched cohort. Results. Of the 1057 patients included in the study, 69 (6.5%) received carboplatin-based ACT. After PSM, 244 total patients were identified in two cohorts that did not differ for baseline characteristics. Death was recorded in 114 (46.7%) patients over a median follow-up of 19 months. Increasing age at surgery (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.01–1.06, p < 0.001) and increasing number of positive lymph nodes (HR 1.06, 95% CI 1.01–1.07, p = 0.02) were independent predictors of worse OS. The delivery of carboplatin-based ACT was not predictive of improved OS (HR 0.67, 95% CI 0.43–1.04, p = 0.08). Conclusions. Carboplatin-based might not improve OS in patients with pN1-3 cM0 BCa. Our results underline the need for alternative therapies for cisplatin-ineligible patients. Carboplatin Chemotherapy Urothelial cancer Bladder cancer Dewey 616 56 Département de médecine 221 false 5145ac62-2247-4522-ab4d-baf195025914 Thesis Public These 11.1.23 _ finale1.pdf 2693034 application/pdf c2740ad2a446c4009c4f51d86d53a1530b758c0fcf09dba54ebcb37b40cf45a9 9d16eda1-a4da-4561-9431-b83c1ab55000 Imprimatur Public Imprimatur thesis luca afferi.pdf 74462 application/pdf ba2ffd2181acbe1a968fb16c9d055d863f1fa28fd42eb190124b08c3375cd736 openAccess Faculté de médecine / Section de médecine clinique / Département de médecine

Title	Published in	Access level	OA Policy	Year	Views	Downloads

Chimiothérapie adjuvante à base de carboplatine versus observation après cystectomie radicale chez les patients atteints d'un cancer urothélial de la vessie pN1-3				2023	269	64

Archive ouverte UNIGE

Afferi, Luca

account_balance Affiliation entities

Affiliation entities