title: Adjuvant chemotherapy is possibly beneficial for locally advanced or node-positive bladder cancer.
abstract: BACKGROUND
  This study aimed to evaluate the outcomes of cisplatin-based adjuvant chemotherapy (AC) after radical cystectomy (RC) in non-organ-confined bladder cancer.
  
  
  METHODS
  Sixty-one patients who did not receive neoadjuvant chemotherapy (NAC) underwent RC for locally advanced (pT3-4) or node-positive (pN1-3) bladder cancer, or both, between 1990 and 2012. Of these patients, 39 (64%) received cisplatin-based AC after RC (AC group) and the remaining 22 patients (36%) did not (non-AC group). Cancer-specific survival (CSS) and recurrence-free survival (RFS) were compared between the groups.
  
  
  RESULTS
  The AC group was significantly younger (P = .004), but no significant differences were noted between the groups for pT stage, pN stage, nuclear grade, renal function, and salvage chemotherapy rates after recurrence. During a follow-up of 29 months (median), 40 patients (67%) experienced recurrence/metastasis and 34 (56%) died of recurrent bladder cancer. The AC group showed better RFS than the non-AC group, but the difference was not statistically significant (median survival time [MST], 23.7 vs. 11.4 months, respectively; P = .154). CSS was significantly better for the AC group than for the non-AC group (MST, 57.4 vs. 17.9 months, respectively; P = .008). On multivariate analysis, AC was an independent predictive factor for both RFS (hazard ratio [HR], 0.325; P = .005) and CSS (HR, 0.186; P < .001), along with surgical margin status and lymphovascular invasion (LVI). In a subgroup analysis of 31 node-positive cases, the AC group had a significantly better CSS compared with the non-AC group (P = .029). Analysis of node-negative cases (n = 30) yielded no significant benefit for AC.
  
  
  CONCLUSIONS
  Our observations suggest that postoperative cisplatin-based AC improves survival in locally advanced or node-positive bladder cancer, especially in node-positive cases.
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kanatani
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan. Electronic address: tohru-tky@umin.ac.jp.
authors.forename: Tohru
authors.initials: T
authors.lastname: Nakagawa
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Taketo
authors.initials: T
authors.lastname: Kawai
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Naito
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Kanae
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Keina
authors.initials: K
authors.lastname: Nozaki
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nagata
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Motofumi
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fujimura
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukuhara
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nishimatsu
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Haruki
authors.initials: H
authors.lastname: Kume
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Igawa
authors.affiliation: Department of Urology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Homma
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000187:drug effects / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Adjuvant chemotherapy; Clinical outcome; Muscle-invasive bladder cancer; Urinary bladder cancer; Urothelial carcinoma