e16126 Background: Although its survival benefit is unclear, adjuvant chemotherapy (CT) is commonly utilized for node-positive bladder cancer after radical cystectomy (RC) and lymph node (LN) dissection. The ideal number of CT cycles is also unknown. Previous studies in patients with metastatic disease administered up to 6 cycles. Lymph node density (LND) (ratio of positive LN/total LN) has been shown to be more important than nodal TNM stage in predicting outcomes after RC, and suggested a 20% LND cutoff for prognosis. This finding also accounted for adjuvant chemotherapy (yes vs. no). We evaluated the long-term outcomes of node-positive pts after RC, according to the number of cycles of adjuvant CT received and adjusting for LND. Methods: The study was IRB approved. Patients still alive were required to give informed consent and accrual is ongoing. Pathological and survival variables of pathologically node-positive pts who underwent RC at the University of Iowa in the last 5 yrs and then received adjuvant CT were retrospectively evaluated. Results: 22 pts have been evaluated to date. Median age was 62 (37–86). Median number of LNs resected was 19.5 and median LND was 19% (3–47). Median survival was 17 mo (10–67). 21 pts received a platinum-gemcitabine combination. The table shows the pt distribution according to no. of CT cycles, LND and number of > 2 yr survivors. Median survival was 17 mo both for pts with LND ≤ 20% and >20% . Median survival of pts with ≤ 4 cycles of CT was 16.5 mo (11–67), with 4 patients still alive at 14–67 months. Median survival of pts who received > 4 cycles of adjuvant CT was 17 mo (10–44), with 3 pts still alive at 29–39 months. Conclusions: The pt distribution table suggests that patients with high LND may have been sicker, and thus less able to receive as many CT cycles. This study is limited by its retrospective nature and small current sample. Accrual is ongoing and updated data will be available. Prospective adjuvant trials could stratify or randomize patients based on LND. [Table: see text] No significant financial relationships to disclose.
