Survival Benefit Persists with Delayed Initiation of Adjuvant Chemotherapy following Radical Cystectomy for Locally Advanced Bladder Cancer.

To determine if delaying the initiation of adjuvant chemotherapy following radical cystectomy for locally advanced bladder cancer worsens overall survival.

This is a retrospective cohort study utilizing the National Cancer Database from 2006-2013. We included treatment-naïve patients who underwent radical cystectomy for muscle-invasive bladder cancer found to have locally advanced disease (pT3-T4 and/or pN+). Patients received no chemotherapy or multi-agent adjuvant chemotherapy between 30 and 180 days following surgery. We used a multivariable Cox Regression to assess for differences in overall survival according to when patients initiated adjuvant chemotherapy.

We identified 3,590 patients: 2,581 received no chemotherapy and 1,009 received multi-agent adjuvant chemotherapy. Adjuvant chemotherapy began 31-60 days post-surgery in 538 patients, 61-90 days in 321 patients, and 91-180 days in 150 patients. Relative to patients who did not receive chemotherapy, adjuvant chemotherapy decreased mortality when started 31-60 days (hazard ratio [HR], 0.60; 95% Confidence Interval [CI], 0.52-0.69; P < 0.001), 61-90 days (HR, 0.62; 95% CI, 0.53-0.74; P < 0.001), and 91-180 days following radical cystectomy (HR, 0.69; 95% CI, 0.55-0.87; P = 0.002).

Adjuvant chemotherapy offers a survival benefit when started up to six months after radical cystectomy in patients with high-risk disease who did not receive neoadjuvant chemotherapy. Patients who require delayed initiation of adjuvant chemotherapy can still benefit from treatment.

Urology. 2019 Jun 11 [Epub ahead of print]

Christopher J Corbett, Leilei Xia, Ronac Mamtani, S Bruce Malkowicz, Thomas J Guzzo

Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA., Department of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA., Department of Medicine, Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA., Department of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA. Electronic address: .

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