Effectiveness of adjuvant chemotherapy in transitional cell carcinoma of the urinary bladder with lymph node involvement and/or lymphovascular invasion treated by radical cystectomy.
OBJECTIVE
To assess the effect of adjuvant chemotherapy on the postoperative survival of patients with transitional cell carcinoma of the bladder and lymph node involvement and/or lymphovascular invasion (LVI).


METHODS
We retrospectively analyzed the data from 260 patients who had undergone radical cystectomy for transitional cell carcinoma of the bladder. Of these 260 patients, 85 (33%) had nodal involvement and 125 (48%) had LVI. Chemotherapy, consisting of three to six cycles of either methotrexate, vinblastine, cisplatin, and doxorubicin or gemcitabine and cisplatin, was administered to 17 (26.6%) of 64 patients with pT3-4N0 disease and 43 (50.6%) of 85 patients with node-positive disease. We determined the factors influencing cancer-specific survival and the effect of chemotherapy according to pathologic stage, LVI, and nodal status. The mean follow-up was 43.8 months (range, 3 to 180; median 33.6).


RESULTS
The overall 5-year cancer-specific survival rate was 65.6%. When we considered nodal involvement and LVI simultaneously, the 5-year survival rate was 92.2% for the node and LVI-negative patients, 60.7% for the node-negative but LVI-positive patients, and 32.5% for the node-positive patients. Chemotherapy was beneficial in the node-positive patients (5-year survival rate of 37.4% versus 26.9%; P = 0.0035) but not beneficial in the node-negative patients, regardless of LVI status. When subclassifying node-positive patients with regard to N stage or LVI status, the effect of chemotherapy was limited to those with Stage N2 (P = 0.002) or LVI-positive status (P = 0.001).


CONCLUSIONS
Adjuvant chemotherapy would be beneficial in patients with node-positive transitional cell carcinoma, especially those with a high nodal disease burden (Stage N2) or LVI, after radical cystectomy.
Park
Jinsung
J
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Park
Sungchan
S
Song
Cheryn
C
Doo
Chinkyung
C
Cho
Yong Mee
YM
Ahn
Hanjong
H
Kim
Choung-Soo
CS
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*