Roger Li, Michael J. Metcalfe, David J. McConkey, Neema Navai, J.E. Ferguson 3rd, Sunil K. Sahai, Colin P. Dinney, Graciela M. Nogueras González, Sharada Mokkapati, Ashish M. Kamat
Objective
To examine the influence of perioperative thiazolidinedione (TZD) on cancer-specific outcomes in patients undergoing radical cystectomy (RC) for urothelial carcinoma (UC).
Design, Setting, and Participants
A retrospective cohort of 173 diabetic patients undergoing RC from 2005 to 2010 was identified. Of those, 53 were on TZD treatment at the time of surgery, with 33 patients taking pioglitazone. Baseline clincopathologic characteristics, as well as cancer specific survival (CSS), recurrence free survival (RFS), and overall survival (OS) were compared between the patients on and off of TZD at the time of RC. In subgroup analysis, outcomes in patients specifically taking pioglitazone at the time of surgery were compared to those not on TZD.
Results
Baseline clinicopathologic characteristics were similar between patients on and off of TZD treatment at the time of RC. Overall, the median CSS rate was not reached in either group (p=0.7). The estimated 5-year CSS was 67.8% in the non-TZD group and 66.3% in the TZD group. On multivariate analysis incorporating patient age, pathologic T staging, and adjuvant chemotherapy, TZD use was found not to be a significant predictor for CSS (HR 1.20; 95% CI, 0.66-2.17, p=0.5). Additionally, recurrence free survival (RFS) (p=0.3) and OS (p=0.2) were also similar between the two groups without adjusting for other variables. Comparison between patients taking pioglitazone vs. patients not taking TZD yielded similar CSS (p=0.2), RFS (p=0.5), and OS (p=0.2).
Conclusions
CSS, as well as RFS and OS after RC were not compromised in patients on TZD therapy at the time of RC. Additional investigation is warranted in non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC) patients undergoing bladder sparing procedures to assess the safety of using TZD in the setting of active UC.
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