title: Adjuvant cisplatin-based combined chemotherapy for lymph node (LN)-positive urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC): a retrospective international study of >1500 patients.
abstract: OBJECTIVE
  To compare outcomes of patients with lymph node (LN)-positive urothelial carcinoma of the bladder (UCB) treated with or without cisplatin-based combined adjuvant chemotherapy (AC) after radical cystectomy (RC).
  
  
  METHODS
  We retrospectively analysed 1523 patients with LN-positive UCB, who underwent RC with bilateral pelvic LN dissection. All patients had no evidence of disease after RC. AC was administered within 3 months. Competing-risks models were applied to compare UCB-related mortality.
  
  
  RESULTS
  Of the 1523 patients, 874 (57.4%) received AC. The cumulative 1-, 2- and 5-year UCB-related mortality rates for all patients were 16%, 36% and 56%, respectively. Administration of AC was associated with an 18% relative reduction in the risk of UCB-related death (subhazard ratio 0.82, P = 0.005). The absolute reduction in mortality was 3.5% at 5 years. The positive effect of AC was detectable in patients aged ≤70 years, in women, in pT3-4 disease, and in those with a higher LN density and lymphovascular invasion. This study is limited by its retrospective and non-randomised design, selection bias, the absence of central pathological review and lack in standardisation of LN dissection and cisplatin-based protocols.
  
  
  CONCLUSIONS
  AC seems to reduce UCB-related mortality in patients with LN-positive UCB after RC. Younger patients, women and those with high-risk features such as pT3-4 disease, a higher LN density and lymphovascular invasion appear to benefit most. Appropriately powered prospective randomised trials are necessary to confirm these findings.
authors.affiliation: Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Lucca
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.forename: Luis
authors.initials: L
authors.lastname: Kluth
authors.forename: Michael
authors.initials: M
authors.lastname: Rink
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
authors.forename: Harun
authors.initials: H
authors.lastname: Fajkovic
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Sebastian L
authors.initials: SL
authors.lastname: Hofbauer
authors.forename: Michela
authors.initials: M
authors.lastname: de Martino
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Quoc-dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Christian
authors.initials: C
authors.lastname: Seitz
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Gero
authors.initials: G
authors.lastname: Kramer
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Tobias
authors.initials: T
authors.lastname: Klatte
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000627:therapeutic use*; D015653:Cystectomy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: adjuvant chemotherapy; lymph node positive; radical cystectomy; survival; urothelial carcinoma of bladder