TY - JOUR
T1 - Adjuvant cisplatin-based combined chemotherapy for lymph node (LN)-positive urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC)
T2 - A retrospective international study of >1500 patients
AU - Lucca, Ilaria
AU - Rouprêt, Morgan
AU - Kluth, Luis
AU - Rink, Michael
AU - Tilki, Derya
AU - Fajkovic, Harun
AU - Kassouf, Wassim
AU - Hofbauer, Sebastian L.
AU - De Martino, Michela
AU - Karakiewicz, Pierre I.
AU - Briganti, Alberto
AU - Trinh, Quoc Dien
AU - Seitz, Christian
AU - Fritsche, Hans Martin
AU - Burger, Maximilian
AU - Lotan, Yair
AU - Kramer, Gero
AU - Shariat, Shahrokh F.
AU - Klatte, Tobias
N1 - Publisher Copyright:
© 2014 The Authors. BJU International © 2014 BJU International.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Objective To compare outcomes of patients with lymph node (LN)-positive urothelial carcinoma of the bladder (UCB) treated with or without cisplatin-based combined adjuvant chemotherapy (AC) after radical cystectomy (RC). Patients and Methods We retrospectively analysed 1523 patients with LN-positive UCB, who underwent RC with bilateral pelvic LN dissection. All patients had no evidence of disease after RC. AC was administered within 3 months. Competing-risks models were applied to compare UCB-related mortality. Results Of the 1523 patients, 874 (57.4%) received AC. The cumulative 1-, 2- and 5-year UCB-related mortality rates for all patients were 16%, 36% and 56%, respectively. Administration of AC was associated with an 18% relative reduction in the risk of UCB-related death (subhazard ratio 0.82, P = 0.005). The absolute reduction in mortality was 3.5% at 5 years. The positive effect of AC was detectable in patients aged ≤70 years, in women, in pT3-4 disease, and in those with a higher LN density and lymphovascular invasion. This study is limited by its retrospective and non-randomised design, selection bias, the absence of central pathological review and lack in standardisation of LN dissection and cisplatin-based protocols. Conclusion AC seems to reduce UCB-related mortality in patients with LN-positive UCB after RC. Younger patients, women and those with high-risk features such as pT3-4 disease, a higher LN density and lymphovascular invasion appear to benefit most. Appropriately powered prospective randomised trials are necessary to confirm these findings.
AB - Objective To compare outcomes of patients with lymph node (LN)-positive urothelial carcinoma of the bladder (UCB) treated with or without cisplatin-based combined adjuvant chemotherapy (AC) after radical cystectomy (RC). Patients and Methods We retrospectively analysed 1523 patients with LN-positive UCB, who underwent RC with bilateral pelvic LN dissection. All patients had no evidence of disease after RC. AC was administered within 3 months. Competing-risks models were applied to compare UCB-related mortality. Results Of the 1523 patients, 874 (57.4%) received AC. The cumulative 1-, 2- and 5-year UCB-related mortality rates for all patients were 16%, 36% and 56%, respectively. Administration of AC was associated with an 18% relative reduction in the risk of UCB-related death (subhazard ratio 0.82, P = 0.005). The absolute reduction in mortality was 3.5% at 5 years. The positive effect of AC was detectable in patients aged ≤70 years, in women, in pT3-4 disease, and in those with a higher LN density and lymphovascular invasion. This study is limited by its retrospective and non-randomised design, selection bias, the absence of central pathological review and lack in standardisation of LN dissection and cisplatin-based protocols. Conclusion AC seems to reduce UCB-related mortality in patients with LN-positive UCB after RC. Younger patients, women and those with high-risk features such as pT3-4 disease, a higher LN density and lymphovascular invasion appear to benefit most. Appropriately powered prospective randomised trials are necessary to confirm these findings.
KW - adjuvant chemotherapy
KW - lymph node positive
KW - radical cystectomy
KW - survival
KW - urothelial carcinoma of bladder
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U2 - 10.1111/bju.12829
DO - 10.1111/bju.12829
M3 - Article
C2 - 24905084
AN - SCOPUS:84927912889
SN - 1464-4096
VL - 115
SP - 722
EP - 727
JO - BJU international
JF - BJU international
IS - 5
ER -