Editorial Comment to Prognostic impact of insulin‐like growth factor‐I and its binding proteins, insulin‐like growth factor‐I binding protein‐2 and ‐3, on adverse histopathological features and survival outcomes after radical cystectomy

摘要

Despite improvements in surgical treatments and systematic therapies, bladder cancer (BC) is still considered a poor prognosis disease with a noticeable impact on health-related quality of life (HRQoL). Radical cystectomy (RC) with urinary diversion (UD) remains the gold-standard of treatment for non-metastatic muscle invasive and high-risk non-muscle invasive disease. The open approach is the most common adopted standard of care, despite robot-assisted RC (RARC) having recently gained popularity. However, the improvement of surgical techniques and greatest adoption of neoadjuvant systematic therapies did not significantly improve prognosis of BC disease. We recently reported outcomes from the first randomized controlled trial comparing open RC and RARC with totally intracorporeal UD, describing the benefit of a totally minimally invasive procedure in terms of 50% reduction of transfusion rates, providing better perioperative surgical outcomes of the robotic cohort.1, 2 However, although we described early preliminary oncologic outcomes, we did not describe any differences between groups, confirming the negligible role of surgical approach on survival outcomes. At the same time, Anceschi et al. recently described the impact of clinical response to neoadjuvant chemotherapy of patients undergoing RARC. While complete response to neoadjuvant chemotherapy was associated with increased overall survival (OS) probability, significant nodal residual disease remained the only independent predictor of OS.3 Moreover, the selection of UD after RC is still controversial, being imperative to consider survival outcomes, even if selection criteria are still mostly related to both patients’ and surgeons’ preferences. To date we have several treatment options aimed to improve patients outcomes, but there are still too much difficulties in recognizing which patient will benefit from one option rather than another, jeopardizing potential benefits of treatments available. Sari Motlagh et al. of the present study should be commended for results obtained, especially for relevant impact on clinical practice.4 Several studies previously aimed to investigate predictive role of different biomarkers, failing to prove any significant association with survival outcomes. However, a larger sample size, prospective evaluation, and external validations are imperative before starting to use plasma levels of insulin-like growth factor binding proteins-2 and -3 in the routine clinical practice. This study for sure offers some food for thought, highlighting the concrete possibility of introducing plasma biomarkers to predict survival outcomes, in order to perform a tailored approach to BC patients, improving HRQoL and cancer control. None declared.