ABSTRACT
Purpose@#This study aims to evaluate the prognosis of pathologically node-positive bladder cancer after neoadjuvant chemotherapy, the role of adjuvant chemotherapy in these patients, and the value of preoperative clinical evaluation for lymph node metastases. @*Materials and Methods@#Patients who received neoadjuvant chemotherapy followed by partial/radical cystectomy and had pathologically confirmed lymph node metastases between January 2007 and December 2019 were identified and analyzed. @*Results@#A total of 53 patients were included in the study. The median age was 61 years (range, 34 to 81 years) with males comprising 86.8%. Among the 52 patients with post-neoadjuvant/pre-operative computed tomography results, only 33 patients (63.5%) were considered positive for lymph node metastasis. Sixteen patients (30.2%) received adjuvant chemotherapy (AC group), and 37 patients did not (no AC group). With the median follow-up duration of 67.7 months, the median recurrence-free survival (RFS) and the median overall survival (OS) was 8.5 months and 16.2 months, respectively. The 2-year RFS and OS rates were 23.3% and 34.6%, respectively. RFS and OS did not differ between the AC group and no AC group (median RFS, 8.8 months vs. 6.8 months, p=0.772; median OS, 16.1 months vs. 16.3 months, p=0.479). Thirty-eight patients (71.7%) experienced recurrence. Distant metastases were the dominant pattern of failure in both the AC group (91.7%) and no AC group (76.9%). @*Conclusion@#Patients with lymph node-positive disease after neoadjuvant chemotherapy followed by surgery showed high recurrence rates with limited survival outcomes. Little benefit was observed with the addition of adjuvant chemotherapy.
ABSTRACT
Infliximab (IFX) is an anti-tumor necrosis factor (TNF) monoclonal antibody used to treat rheumatoid arthritis, ankylosing spondylitis, and Crohn's disease. Rarely, anti-TNF-induced lupus (ATIL) may occur. ATIL differs from classical drug-induced lupus. We report a 49-year-old woman who developed polyarthralgia after 2 years of IFX treatment for Crohn's disease. Based on the autoantibody profiles, ATIL was diagnosed and low-dose glucocorticoid, hydroxychloroquine, and celecoxib were prescribed. However, arthralgia and hemolytic anemia developed. Because the anti-dsDNA titers waxed and waned, she was switched to vedolizumab, a monoclonal antibody to the human lymphocyte α4β7 integrin. Six months after switching treatment, the arthralgia had improved and the anti-dsDNA antibody normalized. Here, we report a case of ATIL that resolved after switching from infliximab to vedolizumab.
Subject(s)
Female , Humans , Middle Aged , Anemia, Hemolytic , Arthralgia , Arthritis, Rheumatoid , Celecoxib , Crohn Disease , Hydroxychloroquine , Infliximab , Lupus Erythematosus, Systemic , Lymphocytes , Necrosis , Spondylitis, AnkylosingABSTRACT
Infliximab (IFX) is an anti-tumor necrosis factor (TNF) monoclonal antibody used to treat rheumatoid arthritis, ankylosing spondylitis, and Crohn's disease. Rarely, anti-TNF-induced lupus (ATIL) may occur. ATIL differs from classical drug-induced lupus. We report a 49-year-old woman who developed polyarthralgia after 2 years of IFX treatment for Crohn's disease. Based on the autoantibody profiles, ATIL was diagnosed and low-dose glucocorticoid, hydroxychloroquine, and celecoxib were prescribed. However, arthralgia and hemolytic anemia developed. Because the anti-dsDNA titers waxed and waned, she was switched to vedolizumab, a monoclonal antibody to the human lymphocyte α4β7 integrin. Six months after switching treatment, the arthralgia had improved and the anti-dsDNA antibody normalized. Here, we report a case of ATIL that resolved after switching from infliximab to vedolizumab.