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Use of Adjuvant Chemotherapy in Patients with Advanced Bladder Cancer after Neoadjuvant Chemotherapy

OBJECTIVES: To compare the outcomes of adjuvant chemotherapy (AC) versus observation in patients with non-organ confined disease after neoadjuvant chemotherapy and radical cystectomy (RC). MATERIALS AND METHODS: Using the National Cancer Database, we identified patients who received NAC prior to RC...

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Autores principales: Sui, Wilson, Lim, Emerson A., Joel Decastro, G., McKiernan, James M., Anderson, Christopher B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: IOS Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545911/
https://www.ncbi.nlm.nih.gov/pubmed/28824946
http://dx.doi.org/10.3233/BLC-170107
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author Sui, Wilson
Lim, Emerson A.
Joel Decastro, G.
McKiernan, James M.
Anderson, Christopher B.
author_facet Sui, Wilson
Lim, Emerson A.
Joel Decastro, G.
McKiernan, James M.
Anderson, Christopher B.
author_sort Sui, Wilson
collection PubMed
description OBJECTIVES: To compare the outcomes of adjuvant chemotherapy (AC) versus observation in patients with non-organ confined disease after neoadjuvant chemotherapy and radical cystectomy (RC). MATERIALS AND METHODS: Using the National Cancer Database, we identified patients who received NAC prior to RC and had advanced stage (pT3/4) or pathologically involved nodes (pN+) at the time of surgery from 2004–2013. We determined whether patients then received AC or were managed with observation only and used multivariable proportional hazards regression to estimate the impact of AC on overall survival. RESULTS: Overall 34% (N = 705) of patients who received NAC and underwent RC were pT3/4 and/or pN+. Of these patients, 24% (N = 168) received subsequent chemotherapy and the rest were observed. Median survival for the entire cohort was 21 months (IQR 12–45). There was not a statistically significant difference in median survival between the AC and observation groups (23 months [IQR 14–46] versus 20 months [IQR 12–46], log-rank p = 0.52). On multivariate analysis there was no survival advantage for the AC cohort. Subgroup analysis of pN+ patients who received AC also did not show a survival advantage. CONCLUSIONS: Patients who are pT3/4 and/or pN+ after NAC and RC have a poor prognosis. The addition of AC does not seem to be beneficial. Further research should focus identifying patients who may benefit from additional chemotherapy.
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spelling pubmed-55459112017-08-16 Use of Adjuvant Chemotherapy in Patients with Advanced Bladder Cancer after Neoadjuvant Chemotherapy Sui, Wilson Lim, Emerson A. Joel Decastro, G. McKiernan, James M. Anderson, Christopher B. Bladder Cancer Research Report OBJECTIVES: To compare the outcomes of adjuvant chemotherapy (AC) versus observation in patients with non-organ confined disease after neoadjuvant chemotherapy and radical cystectomy (RC). MATERIALS AND METHODS: Using the National Cancer Database, we identified patients who received NAC prior to RC and had advanced stage (pT3/4) or pathologically involved nodes (pN+) at the time of surgery from 2004–2013. We determined whether patients then received AC or were managed with observation only and used multivariable proportional hazards regression to estimate the impact of AC on overall survival. RESULTS: Overall 34% (N = 705) of patients who received NAC and underwent RC were pT3/4 and/or pN+. Of these patients, 24% (N = 168) received subsequent chemotherapy and the rest were observed. Median survival for the entire cohort was 21 months (IQR 12–45). There was not a statistically significant difference in median survival between the AC and observation groups (23 months [IQR 14–46] versus 20 months [IQR 12–46], log-rank p = 0.52). On multivariate analysis there was no survival advantage for the AC cohort. Subgroup analysis of pN+ patients who received AC also did not show a survival advantage. CONCLUSIONS: Patients who are pT3/4 and/or pN+ after NAC and RC have a poor prognosis. The addition of AC does not seem to be beneficial. Further research should focus identifying patients who may benefit from additional chemotherapy. IOS Press 2017-07-27 /pmc/articles/PMC5545911/ /pubmed/28824946 http://dx.doi.org/10.3233/BLC-170107 Text en © 2017 – IOS Press and the authors. All rights reserved https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) License (https://creativecommons.org/licenses/by-nc/4.0/) , which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Report
Sui, Wilson
Lim, Emerson A.
Joel Decastro, G.
McKiernan, James M.
Anderson, Christopher B.
Use of Adjuvant Chemotherapy in Patients with Advanced Bladder Cancer after Neoadjuvant Chemotherapy
title Use of Adjuvant Chemotherapy in Patients with Advanced Bladder Cancer after Neoadjuvant Chemotherapy
title_full Use of Adjuvant Chemotherapy in Patients with Advanced Bladder Cancer after Neoadjuvant Chemotherapy
title_fullStr Use of Adjuvant Chemotherapy in Patients with Advanced Bladder Cancer after Neoadjuvant Chemotherapy
title_full_unstemmed Use of Adjuvant Chemotherapy in Patients with Advanced Bladder Cancer after Neoadjuvant Chemotherapy
title_short Use of Adjuvant Chemotherapy in Patients with Advanced Bladder Cancer after Neoadjuvant Chemotherapy
title_sort use of adjuvant chemotherapy in patients with advanced bladder cancer after neoadjuvant chemotherapy
topic Research Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545911/
https://www.ncbi.nlm.nih.gov/pubmed/28824946
http://dx.doi.org/10.3233/BLC-170107
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