Login to Access Video or Poster Abstract: MP58-07
Sources of Funding: none

Introduction

Patients with non-organ confined disease at radical cystectomy (RC) have a poor prognosis, especially after neoadjuvant chemotherapy (NAC). We hypothesized that use of adjuvant chemotherapy (AC) is associated with improved survival compared to observation along among patients with advanced disease at RC after NAC.

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=723) of patients who received NAC and underwent RC were pT3/4 and/or pN+. Of these patients, 24% (N=170) received subsequent chemotherapy and the rest were observed. Median survival for the entire cohort was 21 months (IQR 12-45). Compared to the observation group, the AC group had longer median survival however this was not statistically significant (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 showed 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.

Funding

none