Abstract
This retrospective study compared adjuvant chemotherapy (AC) versus observation after radical cystectomy (RC) in patients with node-positive bladder cancer (pN+). Outcomes were reviewed in patients with pTanyN1-3M0 bladder cancer who underwent RC with or without AC between 1995 and 2017. Baseline characteristics between the two groups were controlled with inverse probability of treatment weighting (IPTW)-adjusted analyses. Of 281 enrolled patients, the 3-year IPTW-adjusted rates of overall survival was higher in the AC group than the RC group (46.4% vs. 33.7%, p = 0.024). AC was an independent predictor of overall survival (hazard ratio = 0.48; P < 0.0001). When patients were subdivided by lymph node density (LND), the 3-year overall survival rates were similar between the AC and RC groups in patients with LND < 9%, but higher in the AC group in patients with LND 9–25% (53.4% vs. 23.7%) and LND ≥ 25% (27.4% vs. 16.1%). The numbers needed to treat to prevent one death at 3 years were three and nine in patients with LND 9–25% and ≥25%, respectively. In conclusion, AC after RC was associated with improved overall survival in patients with node-positive bladder cancer. Patients with an intermediate nodal burden may benefit most from AC.
Highlights
Neoadjuvant chemotherapy prior to surgery was established as the standard of care in advanced bladder cancer based on level I evidence[1], the role of adjuvant chemotherapy (AC) followed by surgery has not yet been fully determined[2]
It is not known whether the effectiveness of AC in lymph node-positive bladder cancer is associated with any clinicopathologic features. pN+ disease was found in approximately 20–25% of patients with muscle-invasive bladder cancer who underwent radical cystectomy (RC) with lymph node dissection[11]
We reported that, in comparison with RC alone, AC after RC was associated with a survival benefit in pN+ bladder cancer patients in both an inverse probability of treatment weighting (IPTW)-adjusted analysis and a time-varying Cox model
Summary
Neoadjuvant chemotherapy prior to surgery was established as the standard of care in advanced bladder cancer based on level I evidence[1], the role of adjuvant chemotherapy (AC) followed by surgery has not yet been fully determined[2]. Randomized trials have been conducted on the benefit of AC in advanced bladder cancer from the early 1990s3–6 until recently[7,8,9,10], these studies evaluated chemotherapy regimens that are no longer in use or had methodological flaws. It is not known whether the effectiveness of AC in lymph node-positive (pN+) bladder cancer is associated with any clinicopathologic features. This study aimed to evaluate the impact of AC after surgery on survival outcomes in patients with pN+ bladder cancer. We attempted to identify patients with pN+ bladder cancer that would be most likely to benefit from AC after RC
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