title: Decreased Overall and Bladder Cancer-Specific Mortality with Adjuvant Chemotherapy After Radical Cystectomy: Multivariable Competing Risk Analysis.
abstract: Adding chemotherapy to radical cystectomy (RC) may improve outcome. Neoadjuvant treatment is advocated by guidelines based on meta-analysis data but is severely underused in clinical practice. Adjuvant treatment of patients at risk could be an alternative. We analyzed a sample of 798 patients who underwent RC between 1993 and 2011 for high-risk superficial or muscle-invasive urothelial or undifferentiated bladder cancer, of which 23% received adjuvant cisplatin-based chemotherapy and %5 received neoadjuvant chemotherapy. The use of adjuvant chemotherapy was an independent predictor of decreased overall mortality (hazard ratio [HR]: 0.50; 95% confidence interval [CI], 0.38-0.66; p<0.0001) and bladder cancer-specific mortality (HR: 0.71; 95% CI, 0.52-0.97; p=0.0321), but it was not associated with competing mortality. Similar figures were obtained when analyzing the number of cisplatin-containing cycles administered or when restricting the analysis to patients with lymph node-positive or extravesical but lymph node-negative disease, suggesting a mortality-reducing treatment effect after adjusting for several patient- and tumor-related confounders. Future trials should directly compare the concepts of neoadjuvant and adjuvant application of chemotherapy in candidates for RC.
  
  
  
  Adjuvant chemotherapy may decrease overall and bladder cancer-specific mortality after radical cystectomy (RC). Future trials should directly compare the concepts of neoadjuvant and adjuvant application of chemotherapy in candidates for RC.
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany. Electronic address: Michael.Froehner@uniklinikum-dresden.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Froehner
authors.affiliation: Department of Medical Statistics and Biometry, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Koch
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Heberling
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Novotny
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Oehlschlaeger
authors.affiliation: Department of Anesthesiology, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hübler
authors.affiliation: Department of Pathology, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany.
authors.forename: Gustavo B
authors.initials: GB
authors.lastname: Baretton
authors.affiliation: Department of Urology, University of Rostock, Rostock, Germany.
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Hakenberg
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany.
authors.forename: Manfred P
authors.initials: MP
authors.lastname: Wirth
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D015653:Cystectomy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D015251:Epirubicin / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008727:Methotrexate / Q000008:administration & dosage; D020360:Neoadjuvant Therapy; D018570:Risk Assessment / Q000379:methods; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D014747:Vinblastine / Q000008:administration & dosage; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D015251:Epirubicin; D014747:Vinblastine; D002945:Cisplatin; D008727:Methotrexate; D000093542:Gemcitabine
keywords: Adjuvant; Bladder; Chemotherapy; Cisplatin; Comorbidity; Competing risk analysis; Cystectomy; Mortality; Proportional hazards model; Urologic neoplasms