Open Access

ARTICLE

Race as a predictor of pathologic response to neoadjuvant chemotherapy at time of cystectomy for bladder cancer

Ankur Choksi¹, Shu Wang¹, Michael Phelan¹, Heather Mannuel², Michael Naslund¹, Mohummad Minhaj Siddiqui¹

1 Division of Urology, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
2 Department of Medicine and Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, Maryland, USA
Address correspondence to Dr. Mohummad Minhaj Siddiqui, Division of Urology, University of Maryland Medical Center, 29 S Greene St Suite 500, Baltimore MD 21201 USA

Canadian Journal of Urology 2021, 28(1), 10547-10555.

Abstract

Introduction: Complete pathologic response (pT0) at time of cystectomy after neoadjuvant chemotherapy (NAC) has been associated with significantly improved clinical outcomes. The goal of this study is to examine whether race is a predictor of pT0 response to NAC at time of cystectomy.
Materials and methods: We analyzed the records of patients diagnosed with a non-metastatic (M0) muscle-invasive (cT2+) urothelial cell bladder cancer in the National Cancer Database (NCDB) who underwent a cystectomy from 2006 to 2014. The cohort was stratified by whether the patient received NAC prior to cystectomy. Univariate and multivariate logistic regression models were used to assess for the effect of race on pathologic complete response after NAC.
Results: We identified 16,036 patients of which 3,195 patients (19.9 %) were treated with NAC prior to cystectomy. The total number of African American (AA) patients in this study was 848 (5.3 %). Compared to Caucasian patients receiving NAC, AA patients had a greater proportion of females and had lower income and education. The rate of pT0 in the surgery only group was 2.7% compared to 15.0% (p < 0.001) for patients treated with NAC. On multivariate analysis, patients of AA race that received NAC were less likely to achieve pT0 (OR = 0.55, 95% CI: 0.31-0.98, p = 0.04) when controlling for age, sex, co-morbidities, income, education and timing of cystectomy after starting NAC.
Conclusions: Our results suggest that African American patients are less likely to achieve pathologic complete response to NAC prior to cystectomy.

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