[Response to adjuvant chemotherapy after radical cystectomy in patients with infiltrative bladder: Analysis of 397 cases].
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).
Monzó Gardiner
Juan Ignacio
JI
Hospital General Universitario Gregorio Marañón, Madrid, España. juanimonzo@hotmail
Herranz Amo
F
F
Cabello Benavente
R
R
Díez Cordero
R
R
López Díez
I
I
Tabares Jiménez
J
J
Molina Escudero
R
R
Paños Facundo
E
E
Hernández Fernández
C
C
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*