title: Adjuvant chemotherapy for invasive bladder cancer: a 2013 updated systematic review and meta-analysis of randomized trials.
abstract: BACKGROUND
  The role of adjuvant chemotherapy remains poorly defined for the management of muscle-invasive bladder cancer (MIBC). The last meta-analysis evaluating adjuvant chemotherapy, conducted in 2005, had limited power to fully support its use.
  
  
  OBJECTIVE
  To update the current evidence of the benefit of postoperative adjuvant cisplatin-based chemotherapy compared with control (ie, surgery alone) in patients with MIBC.
  
  
  METHODS
  A comprehensive literature review was performed to identify all randomized controlled trials (RCTs) comparing adjuvant cisplatin-based chemotherapy with control for patients with MIBC. The search included the Medline, Embase, Cochrane Central Register of Controlled Trials databases, and abstracts from the American Society of Clinical Oncology meetings up to May 2013. An updated systematic review and meta-analysis was performed.
  
  
  RESULTS
  A total of 945 patients included in nine RCTs (five previously analyzed, one updated, and three new) were examined. For overall survival, the pooled hazard ratio (HR) across all nine trials was 0.77 (95% confidence interval [CI], 0.59-0.99; p=0.049). For disease-free survival, the pooled HR across seven trials reporting this outcome was 0.66 (95% CI, 0.45-0.91; p=0.014). This disease-free survival benefit was more apparent among those with positive nodal involvement (p=0.010).
  
  
  CONCLUSIONS
  This updated and improved meta-analysis of randomized trials provides further evidence of an overall survival and disease-free survival benefit in patients with MIBC receiving adjuvant cisplatin-based chemotherapy after radical cystectomy.
authors.affiliation: Harvard School of Public Health, Harvard University, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Leow
authors.affiliation: Harvard School of Public Health, Harvard University, Boston, MA, USA.
authors.forename: William
authors.initials: W
authors.lastname: Martin-Doyle
authors.affiliation: Harvard School of Public Health, Harvard University, Boston, MA, USA.
authors.forename: Padma S
authors.initials: PS
authors.lastname: Rajagopal
authors.affiliation: Harvard School of Public Health, Harvard University, Boston, MA, USA.
authors.forename: Chirayu G
authors.initials: CG
authors.lastname: Patel
authors.affiliation: Harvard School of Public Health, Harvard University, Boston, MA, USA.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Anderson
authors.affiliation: Harvard School of Public Health, Harvard University, Boston, MA, USA.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Rothman
authors.affiliation: Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cote
authors.affiliation: Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
authors.forename: Yuksel
authors.initials: Y
authors.lastname: Urun
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chang
authors.affiliation: Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.affiliation: Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA; University Hospital del Mar-IMIM, Barcelona, Spain. Electronic address: Joaquim_Bellmunt@dfci.harvard.edu.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Bellmunt
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D015653:Cystectomy; D018572:Disease-Free Survival; D006801:Humans; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D016032:Randomized Controlled Trials as Topic; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery
chemical_list: D002945:Cisplatin
keywords: Adjuvant chemotherapy; Meta-analysis; Muscle-invasive bladder cancer; Perioperative chemotherapy