title: Adjuvant chemotherapy in lymph node positive bladder cancer.
abstract: OBJECTIVE
  Lymph node-positive bladder cancer is a systemic disease in the majority of patients. Adjuvant chemotherapy given shortly after surgery, when tumor burden is low, seems reasonable, yet there is no proof that it improves survival. In this retrospective study, we compare the outcomes of patients with microscopic lymph node positive bladder cancer (pN1 or pN2) treated with radical cystectomy followed by adjuvant chemotherapy and those who declined chemotherapy.
  
  
  METHODS
  Sixty-seven patients with lymph node positive bladder cancer (26 pN1 and 41 pN2) who underwent radical cystectomy between April 1995 and April 2005 were reviewed. Combined adjuvant chemotherapy (gemcitabine and cisplatin in most patients) was given to 35 patients (52%), but declined by 32 (48%). The two groups were similar in performance status, postoperative complication rate, and N stage but deferring patients were on average 5 years older and had a more advanced T stage. Study primary endpoint was overall survival (OS).
  
  
  RESULTS
  Adjuvant chemotherapy was well tolerated and 28/35 patients (80%) completed all 4 cycles. Median OS of patients given adjuvant chemotherapy was 48 months compared with 8 months for declining patients (hazard ratio 0.13, 95% CI 0.04-0.4, P < 0.0001). Multivariate age adjusted analysis showed that adjuvant chemotherapy was an independent factor affecting OS (hazard ratio 0.2, P < 0.0001).
  
  
  CONCLUSIONS
  This study supports the use of adjuvant chemotherapy after radical cystectomy in patients with node positive bladder cancer. Study design and patient imbalances make it impossible to draw definitive conclusions.
authors.affiliation: Department of Surgery, Section of Urology, and the Sections of Hematology/Oncology and Biostatistics, University of Chicago, Chicago, IL 60637, USA. ong1000@netvision.net.il
authors.forename: Ofer N
authors.initials: ON
authors.lastname: Gofrit
authors.forename: Walter M
authors.initials: WM
authors.lastname: Stadler
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Zorn
authors.forename: Shang
authors.initials: S
authors.lastname: Lin
authors.forename: Josephine
authors.initials: J
authors.lastname: Silvestre
authors.forename: Arieh L
authors.initials: AL
authors.lastname: Shalhav
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Zagaja
authors.forename: Gary D
authors.initials: GD
authors.lastname: Steinberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery*