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Could adjuvant chemotherapy have therapeutic benefit after neoadjuvant chemotherapy in patients with equal to or greater than pT3 muscle invasive bladder cancer?

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Sources of Funding: none

Introduction

Neoadjuvant chemotherapy (NAC) has been associated with improved prognosis in muscle invasive bladder carcinoma (MIBC) patients. However, the therapeutic effect of adjuvant chemotherapy (AC) following NAC remains unknown.

Methods

We retrospectively identified 576 patients who were treated by radical cystectomy for MIBC at our 7 institutions between 2007 and 2014. Among them, 196 patients with MIBC that was equal to or greater than pT3 were included in the present analysis. We compared the clinical characteristics and outcomes between MIBC patients with and without AC.

Results

Overall, 65 patients (33.2%) were treated by AC. The mean age of the patients with AC (AC group) was 65.9 years, which was significantly lower than that in their counterparts (73.7 years, p<0.001). The AC group had a higher incidence of pathological lymph node positive and concomitant CIS than their counterparts (p=0.002, p=0.018, respectively). The 5-year overall survival rate for the AC group was 46.0%, which was significantly higher than their counterparts (31.2%, p=0.03). Multivariate analysis revealed that the absence of AC (hazard ratio: HR, 1.93, p=0.015) was an independent indicator for death in addition to lymphovascular invasion (HR, 2.06, p=0.002) and pathological lymph node positive (HR, 1.9, p=0.011). In the subgroup of patients without NAC (N=139), 43 patients (30.9%) were treated by AC. The mean age of patients in the AC group was 65.3 years, which was significantly lower than that in their counterparts (74.9 years, p<0.001). The AC group had a higher incidence of pathological lymph node positive than their counterparts (p=0.006). The 5-year overall survival rate for the AC group was 47.5%, which was significantly higher than that in their counterparts (29.4%, p=0.015). Multivariate analysis revealed that the absence of AC (hazard ratio: HR, 2.16, p=0.028) was an independent indicator for death in addition to pathological lymph node positive (HR, 1.98, p=0.025). In the subgroup of patients with NAC (N=57), 22 patients (38.6%) were treated by AC. The 5-year overall survival rate for the AC group (40.2%) was not significantly higher than that in their counterparts (36.0%, p=0.932).

Conclusions

In MIBC patients with a pathological stage equal to or greater than pT3, AC seems to be associated with a better prognosis. However, our data does not support the addition of AC to patients previously treated with NAC.

Funding

none

Authors
Minami Omura
Eiji Kikuchi
Koichiro Ogihara
Kyohei Hakozaki
Keishiro Fukumoto
Go Kaneko
Yasumasa Miyazaki
Nobuyuki Tanaka
Suguru Shirotake
Kunimitsu Kanai
Kazuhiro Matsumoto
Hirohiko Nagata
Akira Miyajima
Mototsugu Oya
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