Building the Case for Adjuvant Chemotherapy after Radical Cystectomy

The main objective of the article published by Galsky et al. was to explore the impact of adjuvant chemotherapy on overall survival (OS) in patients with muscle invasive bladder cancer after radical cystectomy.

This extensive retrospective study analyzed a total of 5,653 patients diagnosed with pathologic T3/4 and/or lymph node positive (pN1-3) urothelial carcinoma of the bladder, who underwent radical cystectomy without prior neoadjuvant chemotherapy between 2003 and 2006. The data were extracted from the National Cancer Data Base (NCDB) which represents a comprehensive registry of more than 1,500 hospitals and includes approximately 70% of all new cancer cases in the United States. Of the 5,653 patients who met the inclusion criteria, 4,360 (77% ) did not receive any treatment after surgery (observation group) and 1,293 (23%) were treated with adjuvant cisplatin-based combination chemotherapy. The analysis demonstrated substantial disparities between the demographic and pathologic characteristics of the adjuvant therapy group (younger, higher median income and grade of education, higher rate of positive surgical margins and / or pN1-3) compared to the observation group. Adjuvant treatment was associatd with a significant improvement in OS (37% in the adjuvant versus 29.1% in the observation group) with a hazard ratio of 0.7 (CI 0.64 - 0.76). The benefit in OS was mantained in all subgroups of patients defined by age, gender, nodal status and number of lymph nodes removed. A sensitivity analysis confirmed the robustness of the data with respect to performance status. The authors concluded that adjuvant cisplatin-based chemotherapy after radical cystectomy leads to a significant increase in OS (p<0.001) in patients with pT3/4 and/or pN1-3 urothelial carcinoma of the bladder.

Urology. 2016 Apr 01 [Epub ahead of print]

Lucia Nappi, Peter C Black, Bernhard J Eigl

British Columbia Cancer Agency, Vancouver, BC; Vancouver Prostate Centre, University of British Columbia, Vancouver, B.C., Vancouver Prostate Centre, University of British Columbia, Vancouver, B.C..  British Columbia Cancer Agency, Vancouver, BC.

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