title: Clinical role of additional adjuvant chemotherapy in patients with locally advanced urothelial carcinoma following neoadjuvant chemotherapy and cystectomy.
abstract: OBJECTIVE
  Neoadjuvant chemotherapy (NAC) can downstage invasive bladder cancers prior to radical cystectomy (RC) and improve overall survival. However, the optimal management in patients with persistent non-organ confined disease (pT3-T4 and/or pN+) following RC has not been completely defined. The aim of this study was to describe outcomes associated with the use of adjuvant chemotherapy (AC) in patients with residual non-organ confined cancer at RC following NAC.
  
  
  METHODS
  Using data from a high-volume referral institution, pT3-T4 and/or pN+ patients who received NAC and then also RC were identified. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were assessed with Kaplan-Meier analysis.
  
  
  RESULTS
  From 2001 to 2013, 161 patients received NAC and then RC. Eighty-eight pT3-T4 and/or pN+ patients were identified. Twenty-nine (33 %) received AC. Adjuvant chemotherapy in the majority of patients was carboplatin-based (16), followed by cisplatin (8) and other, mainly taxane-containing regimens (5). The median RFS was 17.5 months in the AC and 13.7 months in the non-AC group (p = 0.78). AC remained an insignificant predictor for RFS after adjusting for pT, pN and margin status (HR 0.89, 95 % CI 0.48-1.68]). CSS was 23 and 22 months (p = 0.65) and remained insignificant after adjusting for pathologic confounders.
  
  
  CONCLUSIONS
  In our current study population, adjuvant conventional cytotoxic chemotherapy was not associated with significant improvements in RFS or CSS. The choice of AC regimens, and incorporation of newer treatments, may be the key for improving outcomes in this high-risk patient group.
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
authors.forename: Kamran
authors.initials: K
authors.lastname: Zargar-Shoshtari
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Kongnyuy
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
authors.forename: Pranav
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
authors.forename: Mayer N
authors.initials: MN
authors.lastname: Fishman
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Gilbert
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Poch
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
authors.forename: Julio M
authors.initials: JM
authors.lastname: Pow-Sang
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Spiess
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
authors.forename: Jingsong
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA. wade.sexton@moffitt.org.
authors.forename: Wade J
authors.initials: WJ
authors.lastname: Sexton
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*
keywords: Adjuvant chemotherapy; Cystectomy; Neoadjuvant therapy; Survival; Urinary bladder neoplasms