A comparison of the outcomes after neoadjuvant (NC) or adjuvant chemotherapy (AC) for muscle-invasive urothelial bladder cancer (UC): A French contemporary retrospective multicenter cohort.

Abstract

325 Background: Our aim was to investigate outcome of patients (pts) treated with AC or NC for organ-confined UC, or with NC for clinical lymph node involvement (cN+). Methods: We retrospectively analyzed 482 pts treated in 22 French hospitals between 2000 and 2013 in 3 settings: 226 pts with radical cystectomy (RC) and AC (AC group), 193 cN0 (NC group), and 63 cN+ (cN+ group) pts received NC before a planned RC for cT2-T4, M0 UC. The primary outcome was overall survival (OS). Cancer-related survival (CRS) was also evaluated. Multivariate Cox proportional hazards regression was used to estimate adjusted hazard ratios with 95% confidence interval. Results: Median age was 62, 61.7, and 62.1 in AC, NC, and cN+, respectively. Median time between diagnosis and first treatment (RC or NC) was 2.1, 1.4 and 1.6 months, respectively (p<0.001). In AC, stages were p≤T2 (n=46) or pT≥3 (n=180), pN0 (n=37), pN+ (n=168), or pNx (n=21). Gemcitabine-cisplatin and gemcitabine-carboplatin regimen were mainly delivered as AC in 71.2% and 21.7% of pts. In NC, all pts received methotrexate-vinblastine-doxorubicin-cisplatin (MVAC) or dose-dense MVAC. Median number of cycles was 4 in each group. After NC, RC has been realized in 173 (90%) and 51 pts (82%) in NC and cN+, respectively. In 17 unoperated pts, concomitant chemoradiotherapy was performed. Median follow-up was 24.6 months. Respectively, 133 (59%), 61 (32%), and 22 (35%) pts have relapsed in AC, NC, and cN+; 74%, 63%, and 71% of them received chemotherapy for metastasis. Also 133 (59%), 41 (21%), and 18 (29%) pts died, mostly (90%) due to recurrence. Three-year OS and CRS rates were 54%, 68%, and 56% (p=0.02), and 37%, 53%, and 49% (p=0.038) in AC, NC, and cN+, respectively. In multivariate analysis, only AC (HR: 1.64, 95% CI 1.18-2.30, p=0.001) remained significantly associated with shortened OS. Conclusions: In this large retrospective study reporting real-life survivals, 3-year OS was longer in pts receiving NC, both in cN0 and in cN+ groups, than in pts treated with AC. Although several selection bias can be emphasized preventing us from drawing definitive conclusions, AC appeared to be associated with a poorer prognosis.