Adding chemotherapy to radical cystectomy (RC) may improve outcome. Neoadjuvant treatment is advocated by guidelines based on meta-analysis data but is severely underused in clinical practice. Adjuvant treatment of patients at risk could be an alternative.
We analyzed a sample of 798 patients who underwent RC between 1993 and 2011 for high-risk superficial or muscle-invasive urothelial or undifferentiated bladder cancer, of which 23% received adjuvant cisplatin-based chemotherapy and %5 received neoadjuvant chemotherapy. The use of adjuvant chemotherapy was an independent predictor of decreased overall mortality (hazard ratio [HR]: 0. 50; 95% confidence interval [CI], 0. 38-0. 66; p
Adjuvant chemotherapy may decrease overall and bladder cancer-specific mortality after radical cystectomy (RC). Future trials should directly compare the concepts of neoadjuvant and adjuvant application of chemotherapy in candidates for RC.
European urology. 2015 Jul 17 [Epub ahead of print]
Michael Froehner, Rainer Koch, Ulrike Heberling, Vladimir Novotny, Sven Oehlschlaeger, Matthias Hübler, Gustavo B Baretton, Oliver W Hakenberg, Manfred P Wirth
Department of Urology, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany. Department of Medical Statistics and Biometry, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany. , Department of Urology, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany. , Department of Urology, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany. , Department of Urology, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany. , Department of Anesthesiology, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany. , Department of Pathology, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany. , Department of Urology, University of Rostock, Rostock, Germany. , Department of Urology, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany.