529 NEOADJUVANT GEMCITABINE PLUS CARBOPLATIN FOLLOWED BY IMMEDIATE RADICAL CYSTECTOMY IN PATIENTS WITH MUSCLE-INVASIVE BLADDER CANCER: A PROPENSITY SCORE ANALYSIS

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You have accessJournal of UrologyUrothelial Cancer: Medical & Surgical Therapy1 Apr 2012529 NEOADJUVANT GEMCITABINE PLUS CARBOPLATIN FOLLOWED BY IMMEDIATE RADICAL CYSTECTOMY IN PATIENTS WITH MUSCLE-INVASIVE BLADDER CANCER: A PROPENSITY SCORE ANALYSIS Takuya Koie, Akiko Okamoto, Hayato Yamamoto, Yuki Tobisawa, Tohru Yoneyama, Kazuyuki Mori, Shingo Hatakeyama, Takahiro Yoneyama, Yasuhiro Hashimoto, Noritaka Kamimura, and Chikara Ohyama Takuya KoieTakuya Koie Hirosaki, Japan More articles by this author , Akiko OkamotoAkiko Okamoto Hirosaki, Japan More articles by this author , Hayato YamamotoHayato Yamamoto Hirosaki, Japan More articles by this author , Yuki TobisawaYuki Tobisawa Hirosaki, Japan More articles by this author , Tohru YoneyamaTohru Yoneyama Hirosaki, Japan More articles by this author , Kazuyuki MoriKazuyuki Mori Hirosaki, Japan More articles by this author , Shingo HatakeyamaShingo Hatakeyama Hirosaki, Japan More articles by this author , Takahiro YoneyamaTakahiro Yoneyama Hirosaki, Japan More articles by this author , Yasuhiro HashimotoYasuhiro Hashimoto Hirosaki, Japan More articles by this author , Noritaka KamimuraNoritaka Kamimura Hirosaki, Japan More articles by this author , and Chikara OhyamaChikara Ohyama Hirosaki, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.602AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Standard neoadjuvant chemotherapy has not yet been established for patients with muscle-invasive bladder cancer. Our pervious phase II trial demonstrated the efficacy and safety of neoadjuvant gemcitabine plus carboplatin (GCarb) chemotherapy followed by immediate cystectomy in patients with muscle-invasive bladder cancer. In the present study, we conducted a propensity score analysis to elucidate clinical significance of the present treatment protocol. METHODS The cohort of neoadjuvant group consists of 120 patients with muscle-invasive bladder cancer. They received 2 courses of GCarb therapy consisting of 800 mg/m2 gemcitabine on days 1, 8, and 15 and carboplatin with an AUC of 4 on day 2 between March 2005 and June 2011. After the chemotherapy, radical cystectomy (RC) and bilateral pelvic lymph node dissection (PLND) were performed at an interval of 1 month. The cohort of RC alone group includes 155 patients with muscle-invasive bladder cancer treated with RC and bilateral PLND between May 1994 and December 2004. Propensity score matching was used to adjust for potential selection biases associated with treatment type. The endpoints were Overall (OS) and disease-free survival (DFS). RESULTS Of the 120 patients who received GCarb and RC, 28 (23.3%) RC specimens showed pT0. The mean interval from the time of diagnosis of muscle-invasive bladder cancer to RC was 61 days. Grade 3/4 neutropenia occurred in 40 patients (33.9%) and thrombocytopenia in 23 patients (19.8%). Propensity score-matched analysis indicated 112 matched pairs from both groups. The median follow-up period was 35.9 months. The 5-year OS rate was 91.5% for neoadjuvant GCarb versus 51.3% for RC alone group (P < 0.0001). The DFS rate was 83.8% for neoadjuvant GCarb versus 53.1% for RC alone (P < 0.0001). Multivariate analysis revealed that the neoadjuvant GCarb regimen was an extremely strong predictor of the improvement in OS and DFS. CONCLUSIONS Although the present study is not randomized, neoadjuvant gemcitabine plus carboplatin therapy followed by immediate RC achieved significantly longer OS and DFS comparing to surgery alone. The clinical usefulness of the present treatment for the patient with muscle-invasive bladder cancer should be verified by further trials. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e217-e218 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takuya Koie Hirosaki, Japan More articles by this author Akiko Okamoto Hirosaki, Japan More articles by this author Hayato Yamamoto Hirosaki, Japan More articles by this author Yuki Tobisawa Hirosaki, Japan More articles by this author Tohru Yoneyama Hirosaki, Japan More articles by this author Kazuyuki Mori Hirosaki, Japan More articles by this author Shingo Hatakeyama Hirosaki, Japan More articles by this author Takahiro Yoneyama Hirosaki, Japan More articles by this author Yasuhiro Hashimoto Hirosaki, Japan More articles by this author Noritaka Kamimura Hirosaki, Japan More articles by this author Chikara Ohyama Hirosaki, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...