The role of adjuvant chemotherapy in patients with locally advanced (pT3, pT4a) and/or lymph node–positive bladder cancer

• Published in: International urology and nephrology Vol. 42; no. 4; pp. 959 - 964
• Main Authors: Resorlu, Berkan, Türkölmez, Kadir, Ergün, Gül, Baltaci, Sümer, Göüs, Çaatay, Bedük, Yasar
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.12.2010; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Bladder cancer; Chemotherapy, Adjuvant; Female; Follow-Up Studies; Humans; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Nephrology; Retrospective Studies; Urinary Bladder Neoplasms - drug therapy; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urology; Urology – Original Paper; Adjuvant chemotherapy; Prognosis; Bladder cancer; Radical cystectomy; Cisplatin
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-010-9736-5

Objective To report the long-term follow up of patients with locally advanced bladder cancer treated with either adjuvant chemotherapy with gemcitabine/cisplatin (GC) or methotrexate, vinblastine, epirubicin, and cisplatin (MVEC) or no additional treatment after radical cystectomy, to examine various survival endpoints and factors associated with long-term survival. Patients and methods Seventy-eight patients undergoing radical cystectomy for pathologic stage T3, T4 or lymph node–positive (N+) bladder cancer were divided to observation group (46 patients) and adjuvant chemotherapy group (32 patients). Data were obtained for recurrence free (RFS) and overall survival (OS). Results One-, 2- and 5-year RFS rates were 74, 56.8 and 51.1% for chemotherapy arm, whereas these ratios were 50.6, 31 and 27.6% for control arm, respectively ( P  = 0.032). RFS rates were significantly better in patients with lymph node–negative disease than in those with positive lymph nodes for control arm ( P  = 0.007), but for the chemotherapy arm there was no statistical difference between patients with lymph node–negative and –positive disease ( P  = 0.28). Mean OS and RFS times were 31.03 and 28.4 months for chemotherapy arm, while they were 22.17 and 18.09 months for control arm, respectively ( P  = 0.142, P  = 0.196). On multivariate analysis, lymph node metastasis and adjuvant chemotherapy remained significant independent prognostic factors for cancer-specific survival. Conclusions Bladder cancer is chemosensitive, and using adjuvant chemotherapy is likely to improve the outcome of local treatment and to decrease the rates of distant metastases.