Clinical Epidemiology and Ageing

Adjuvant Chemotherapy After Radical Cystectomy for Urothelial Bladder Cancer: Outcome and Prognostic Factors for Survival in a French Multicenter, Contemporary Cohort.

Pouessel D, Bastuji-Garin S, Houédé N, Vordos D, Loriot Y, Chevreau C, Sevin E, Beuzeboc P, de la Taille A, Le Thuaut A, Allory Y, Culine S Clin Genitourin Cancer. 2017;15(1):e45-e52.

<p><b>BACKGROUND: </b>In the past decade, adjuvant chemotherapy (AC) after radical cystectomy (RC) was preferred worldwide for patients with muscle-invasive urothelial bladder cancer. In this study we aimed to determine the outcome of patients who received AC and evaluated prognostic factors associated with survival.</p><p><b>PATIENTS AND METHODS: </b>We retrospectively analyzed 226 consecutive patients treated in 6 academic hospitals between 2000 and 2009. Multivariate Cox proportional hazards regression adjusted for center to estimate adjusted hazard ratios (HRs) with 95% confidence intervals were used.</p><p><b>RESULTS: </b>The median age was 62.4 (range, 35-82) years. Patients had pT3/pT4 and/or pN+ in 180 (79.6%) and 168 patients (74.3%), respectively. Median lymph node (LN) density was 25% (range, 3.1-100). Median time between RC and AC was 61.5 (range, 18-162) days. Gemcitabine with cisplatin, gemcitabine with carboplatin, and MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) regimens were delivered in 161 (71.2%), 49 (21.7%), and 12 patients (5.3%) of patients, respectively. The median number of cycles was 4 (range, 1-6). Thirteen patients (5.7%) with LN metastases also received adjuvant pelvic radiotherapy (ART). After a median follow-up of 4.2 years, 5-year overall survival (OS) was 40.7%. In multivariate analysis, pT ≥3 stage (HR, 1.73; P = .05), LN density >50% (HR, 1.94; P = .03), and number of AC cycles <4 (HR, 4.26; P = .001) were adverse prognostic factors for OS. ART (HR, 0.30; P = .05) tended to provide survival benefit.</p><p><b>CONCLUSION: </b>Classical prognostic features associated with survival are not modified by the use of AC. Patients who derived benefit from AC had a low LN density and received at least 4 cycles of treatment.</p>

MeSH terms: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Carboplatin; Chemotherapy, Adjuvant; Cisplatin; Cystectomy; Deoxycytidine; Disease-Free Survival; Doxorubicin; Female; France; Gemcitabine; Humans; Lymphatic Metastasis; Male; Methotrexate; Middle Aged; Prognosis; Retrospective Studies; Survival Analysis; Treatment Outcome; Urinary Bladder Neoplasms; Vinblastine
DOI: 10.1016/j.clgc.2016.07.012