Evaluating residual tumor after neoadjuvant chemotherapy for muscle-invasive urothelial bladder cancer: Diagnostic performance and outcomes using biparametric vs. multiparametric MRI Journal Article
| Authors: | Woo, S.; Becker, A. S.; Das, J. P.; Ghafoor, S.; Arita, Y.; Benfante, N.; Gangai, N.; Teo, M. Y.; Goh, A. C.; Vargas, H. A. |
| Article Title: | Evaluating residual tumor after neoadjuvant chemotherapy for muscle-invasive urothelial bladder cancer: Diagnostic performance and outcomes using biparametric vs. multiparametric MRI |
| Abstract: | Background: Neoadjuvant chemotherapy (NAC) before radical cystectomy is standard of care in patients with muscle-invasive bladder cancer (MIBC). Response assessment after NAC is important but suboptimal using CT. We assessed MRI without vs. with intravenous contrast (biparametric [BP] vs. multiparametric [MP]) for identifying residual disease on cystectomy and explored its prognostic role. Methods: Consecutive MIBC patients that underwent NAC, MRI, and cystectomy between January 2000–November 2022 were identified. Two radiologists reviewed BP-MRI (T2 + DWI) and MP-MRI (T2 + DWI + DCE) for residual tumor. Diagnostic performances were compared using receiver operating characteristic curve analysis. Kaplan-Meier curves and Cox proportional-hazards models were used to evaluate association with disease-free survival (DFS). Results: 61 patients (36 men and 25 women; median age 65 years, interquartile range 59–72) were included. After NAC, no residual disease was detected on pathology in 19 (31.1%) patients. BP-MRI was more accurate than MP-MRI for detecting residual disease after NAC: area under the curve = 0.75 (95% confidence interval (CI), 0.62–0.85) vs. 0.58 (95% CI, 0.45–0.70; p = 0.043). Sensitivity were identical (65.1%; 95% CI, 49.1–79.0) but specificity was higher in BP-MRI compared with MP-MRI for determining residual disease: 77.8% (95% CI, 52.4–93.6) vs. 38.9% (95% CI, 17.3–64.3), respectively. Positive BP-MRI and residual disease on pathology were both associated with worse DFS: hazard ratio (HR) = 4.01 (95% CI, 1.70–9.46; p = 0.002) and HR = 5.13 (95% CI, 2.66–17.13; p = 0.008), respectively. Concordance between MRI and pathology results was significantly associated with DFS. Concordant positive (MRI+/pathology+) patients showed worse DFS than concordant negative (MRI-/pathology-) patients (HR = 8.75, 95% CI, 2.02–37.82; p = 0.004) and compared to the discordant group (MRI+/pathology- or MRI-/pathology+) with HR = 3.48 (95% CI, 1.39–8.71; p = 0.014). Conclusion: BP-MRI was more accurate than MP-MRI for identifying residual disease after NAC. A negative BP-MRI was associated with better outcomes, providing complementary information to pathological assessment of cystectomy specimens. © 2023, The Author(s). |
| Keywords: | survival; adult; cancer survival; treatment outcome; treatment response; aged; retrospective studies; major clinical study; clinical feature; cisplatin; doxorubicin; gemcitabine; paclitaxel; cancer patient; disease free survival; neoadjuvant therapy; gadolinium; methotrexate; magnetic resonance imaging; cancer diagnosis; diagnostic accuracy; sensitivity and specificity; carboplatin; etoposide; pathology; diagnostic imaging; retrospective study; bladder tumor; urinary bladder neoplasms; vinblastine; confidence interval; proportional hazards model; radiologist; diagnostic value; minimal residual disease; neoplasm, residual; radical cystectomy; cystectomy; intermethod comparison; hazard ratio; kaplan meier method; neoadjuvant chemotherapy; dynamic contrast-enhanced magnetic resonance imaging; diffusion weighted imaging; receiver operating characteristic; urothelial; muscle; muscles; response assessment; diagnostic test accuracy study; muscle invasive bladder cancer; procedures; cancer prognosis; muscle-invasive bladder cancer; multiparametric magnetic resonance imaging; humans; prognosis; human; male; female; article; multiparametric; t2 weighted imaging; biparametric; biparametric magnetic resonance imaging |
| Journal Title: | Cancer Imaging |
| Volume: | 23 |
| ISSN: | 1470-7330 |
| Publisher: | Biomed Central Ltd |
| Date Published: | 2023-11-14 |
| Start Page: | 110 |
| Language: | English |
| DOI: | 10.1186/s40644-023-00632-0 |
| PUBMED: | 37964386 |
| PROVIDER: | scopus |
| PMCID: | PMC10644594 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Sungmin Woo -- Source: Scopus |
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