title: [Response to adjuvant chemotherapy after radical cystectomy in patients with infiltrative bladder: Analysis of 397 cases].
abstract: OBJECTIVE
  To define the usefulness of adjuvant chemo-therapy in patients with pT2, pN0, pT3-4, pN0 and pN+ disease.
  
  
  METHODS
  Retrospective analysis of 397 patients with transitional bladder cancer who underwent radical cys-tectomy between 1986 and 2005. Adjuvant chemo-therapy was administered to 40.2% of patients. Three cycles of adjuvant MVAC (methotrexate, vinblastine, adriamycin and cisplatin) were given.
  
  
  RESULTS
  In patients with pT3, pN0 (p=0.04) and/or N+ stages (p=0.001), adjuvant chemotherapy significantly improved cancer-specific survival, which did not occur in pT2N0 (p=0.9) and pT4, pN0 (p=0.6) patients. In the univariate analysis, adjuvant chemotherapy was significantly associated with a lower cancer-specific survival rate (RR 1.452 95% CI: 1.028- 2.057 p= 0.03), while the multivariate analysis showed a trend (RR: 0.651 95% CI 0.398-1.065, p=0.08) towards a decrease in cancer-specific mortality.
  
  
  CONCLUSIONS
  Although adjuvant chemotherapy was not shown to improve survival in patients with pT0-2, pN0 and pT4, pN0 disease, it did increase survival in those with extravesical disease, pathological state T3, pN0 and/or pN+. Considering its tendency to improve cancer-specific survival, adjuvant chemotherapy may be considered as a "protective factor" (RR=0.651, p=0.08).
authors.affiliation: Hospital General Universitario Gregorio Marañón, Madrid, España. juanimonzo@hotmail
authors.forename: Juan Ignacio
authors.initials: JI
authors.lastname: Monzó Gardiner
authors.forename: F
authors.initials: F
authors.lastname: Herranz Amo
authors.forename: R
authors.initials: R
authors.lastname: Cabello Benavente
authors.forename: R
authors.initials: R
authors.lastname: Díez Cordero
authors.forename: I
authors.initials: I
authors.lastname: López Díez
authors.forename: J
authors.initials: J
authors.lastname: Tabares Jiménez
authors.forename: R
authors.initials: R
authors.lastname: Molina Escudero
authors.forename: E
authors.initials: E
authors.lastname: Paños Facundo
authors.forename: C
authors.initials: C
authors.lastname: Hernández Fernández
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*