Effect of adjuvant chemotherapy in locally advanced urothelial carcinoma of the bladder treated with cystectomy.

Currently, the role of adjuvant chemotherapy (ADJ) in muscle invasive bladder tumor remains controversial.

To evaluate the effect of ADJ on cancer specific survival of muscle invasive bladder tumor after radical cystectomy (RC).

Retrospective analysis of 292 patients diagnosed with urothelial bladder tumor pT3-4pN0 / + cM0 stage, treated with RC between 1986-2009. Total cohort was divided in two groups: 185 (63.4%) patients treated with ADJ and 107 (36.6%) without ADJ. Median follow-up was 40.5 months (IQR 55-80.5). Comparative analysis was performed with Chi-square test and Student's t test /ANOVA. Survival analysis was carried out with the Kaplan-Meier method and log-rank test. Multivariate analysis (Cox regression) was made to identify independent predictors of cancer-specific mortality (CSM).

42.8% of the series presented lymph node involvement after RC. At the end of follow-up, 22.9% were BC-free and 54.8% had died due to this cause. The median cancer specific survival was 30 months. No significant differences were observed in cancer specific survival regarding the treatment with ADJ in pT3pN0 (p=.25) or pT4pN0 (p=.29) patients, but it was significant in pT3-4pN+ (p=.001). Multivariate analysis showed pathological stage (p=.0001) and treatment with ADJ (p=.007) as independent prognostic factors for CSM. ADJ reduced the risk of CSM (HR:0.59,95% CI 0.40-0.87, p=.007).

pT and pN stages were identified as independent predictors of CSM after RC. The administration of ADJ in our series behaved as a protective factor reducing the risk of CSM, although only pN+ patients were benefited in the stage analysis.

Actas urologicas espanolas. 2019 Dec 19 [Epub ahead of print]

G Del Pozo Jiménez, F Herranz Amo, J A Arranz Arija, E Rodríguez Fernández, D Subirá Ríos, E Lledó García, G Bueno Chomón, M J Cancho Gil, J Carballido Rodríguez, C Hernández Fernández

Servicio de Urología, Hospital Universitario Puerta de Hierro, Madrid, España. Electronic address: ., Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, España., Servicio de Urología, Hospital Universitario Puerta de Hierro, Madrid, España.