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

14510 Background: A recent meta-analysis has demonstrated a 25% relative risk reduction of death and an absolute survival benefit of 9% at 3 years for adjuvant chemotherapy following radical cystectomy (RCx) for lymph node positive bladder cancer. It was the aim of our analysis to identify predictors of survival following standard chemotherapy in lymph node positive bladder cancer. Methods: A retrospective analysis of 156 consecutive patients with lymph node positive urothelial bladder cancer was performed. All patients underwent systemic chemotherapy with 4 cycles gemictabine/cisplatin 4 to 6 weeks after RCx. The prognostic significance of the number of positive lymph nodes, lymph node diameter, extranodal extension, bilateral lymph node involvement, pT stage, grade, tumor diameter, presence of lymphatic (LI) or vascular invasion (VI) was analysed. Statistical analysis was performed by uni- and multivariate analysis. Results: Median follow-up is 6.5 (12 â€“ 3.5) years, minimum follow-up is 36 months. Median survival time is 56 months, 56% of the patients died due to tumor progression. pT stage (p = 0.002), tumor diameter (p = 0.005), LI (p = 0.0015) or VI (p = 0.0028), lymph node diameter (p = 0.026) and extranodal extension (p = 0.0002) were significant risk factors associated with survival by univariate analysis. Neither the number or bilaterality of positive lymph nodes nor tumor grade were associated with survival time. On multivariate analysis only extranodal extension (p = 0.001) and tumor diameter (p = 0.05) remained significant and independent prognostic predictors. Median survival was 64 and 21 months in patients with or w/o extranodal extension (p = 0.0001), resp.; median survival was 81 and 28 months in patients w/o and with LI/VI (p = 0.001). In patients with extranodal extension or LI/VI adjuvant chemotherapy had no impact on survival. Conclusions: Analysis of multiple pathohistological and clinical parameters reveal that extranodal extension, primary tumor diameter and presence of LI/VI represent risk factors predicting survival following adjuvant chemotherapy in lymph node positive bladder cancer. Patients exhibiting these adverse factors might be considered for a more aggressive systemic approach. No significant financial relationships to disclose.

Download Full-text

Adjuvant chemotherapy in lymph node positive bladder cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.15526 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 15526-15526

Author(s):

O. N. Gofrit ◽

W. M. Stadler ◽

K. C. Zorn ◽

J. Silvestre ◽

A. L. Shalhav ◽

...

Keyword(s):

Bladder Cancer ◽

Lymph Node ◽

Adjuvant Chemotherapy ◽

Radical Cystectomy ◽

Systemic Disease ◽

Performance Status ◽

Real Life ◽

Hazard Ratio ◽

Node Positive ◽

Lymph Node Positive

15526 Background: Lymph node-positive bladder cancer is a systemic disease in the majority of patients. Prescribing adjuvant chemotherapy shortly after surgery, when tumor burden is low seems reasonable, yet there is no proof that this treatment strategy improves survival. In this retrospective study, we compared the outcomes of patients with microscopic lymph node positive bladder cancer (pN1 or pN2) treated with radical cystectomy followed by adjuvant chemotherapy and those who declined chemotherapy. Methods: Sixty-seven patients with lymph node positive bladder cancer (pN1 in 26 patients and pN2 in 41) who underwent radical cystectomy between April 1995 and April 2005 were reviewed. Combined adjuvant chemotherapy (gemcitabine and cisplatin in most patients) was given to 35 patients (52%), but deferred by 32 (48%). The two groups were similar in performance status, postoperative complication rate and N stage but deferring patients were on average 4 years older and had a more advanced T stage. Results: Adjuvant chemotherapy was well tolerated with 28/35 patients (80%) completed all 4 cycles. Median overall survival of patients given adjuvant chemotherapy was 48 months compared to 8 months for deferring patients (hazard ratio 0.13, 95% CI 0.04–0.4, p<0.0001). Multivariate age adjusted analysis showed that adjuvant chemotherapy was an independent factor affecting overall survivals (hazard ratio 0.2, p<0.0001). Subgroup analysis demonstrated that chemotherapy provided survival benefit for patients with pN2 disease but not for patients with pN1 disease (p=0.0001 and p=0.235 respectively). Conclusions: This retrospective real-life study supports the use of adjuvant chemotherapy after radical cystectomy in patients with node positive bladder cancer, especially when more than one lymph node is involved. No significant financial relationships to disclose.

Download Full-text