Adjuvant cisplatin-based combined chemotherapy for lymph node (LN)-positive urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC): A retrospective international study of >1500 patients

Ilaria Lucca, Morgan Rouprêt, Luis Kluth, Michael Rink, Derya Tilki, Harun Fajkovic, Wassim Kassouf, Sebastian L. Hofbauer, Michela De Martino, Pierre I. Karakiewicz, Alberto Briganti, Quoc Dien Trinh, Christian Seitz, Hans Martin Fritsche, Maximilian Burger, Yair Lotan, Gero Kramer, Shahrokh F. Shariat, Tobias Klatte

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18 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)722-727
Number of pages6
JournalBJU international
Volume115
Issue number5
DOIs
StatePublished - May 1 2015

Keywords

  • adjuvant chemotherapy
  • lymph node positive
  • radical cystectomy
  • survival
  • urothelial carcinoma of bladder

ASJC Scopus subject areas

  • Urology

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