title: Adjuvant Chemotherapy After Radical Cystectomy for Urothelial Bladder Cancer: Outcome and Prognostic Factors for Survival in a French Multicenter, Contemporary Cohort.
abstract: In the past decade, adjuvant chemotherapy (AC) after radical cystectomy (RC) was preferred worldwide for patients with muscle-invasive urothelial bladder cancer. In this study we aimed to determine the outcome of patients who received AC and evaluated prognostic factors associated with survival.
  
  
  
  We retrospectively analyzed 226 consecutive patients treated in 6 academic hospitals between 2000 and 2009. Multivariate Cox proportional hazards regression adjusted for center to estimate adjusted hazard ratios (HRs) with 95% confidence intervals were used.
  
  
  
  The median age was 62.4 (range, 35-82) years. Patients had pT3/pT4 and/or pN+ in 180 (79.6%) and 168 patients (74.3%), respectively. Median lymph node (LN) density was 25% (range, 3.1-100). Median time between RC and AC was 61.5 (range, 18-162) days. Gemcitabine with cisplatin, gemcitabine with carboplatin, and MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) regimens were delivered in 161 (71.2%), 49 (21.7%), and 12 patients (5.3%) of patients, respectively. The median number of cycles was 4 (range, 1-6). Thirteen patients (5.7%) with LN metastases also received adjuvant pelvic radiotherapy (ART). After a median follow-up of 4.2 years, 5-year overall survival (OS) was 40.7%. In multivariate analysis, pT ≥3 stage (HR, 1.73; P = .05), LN density >50% (HR, 1.94; P = .03), and number of AC cycles <4 (HR, 4.26; P = .001) were adverse prognostic factors for OS. ART (HR, 0.30; P = .05) tended to provide survival benefit.
  
  
  
  Classical prognostic features associated with survival are not modified by the use of AC. Patients who derived benefit from AC had a low LN density and received at least 4 cycles of treatment.
authors.affiliation: Inserm U955 Hôpital Henri Mondor, Team 7 Translational Research of Genito-Urinary Oncogenesis, Créteil, France; Department of Medical Oncology, Hôpital Saint-Louis, AP-HP, Paris, France. Electronic address: damien.pouessel@aphp.fr.
authors.forename: Damien
authors.initials: D
authors.lastname: Pouessel
authors.affiliation: CEpiA (Clinical Epidemiology and Ageing), Unit EA 4393, Paris Est University, Créteil, France; Public Health Department, Hôpital Henri-Mondor, AP-HP, Créteil, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bastuji-Garin
authors.affiliation: Department of Medical Oncology, Institut Bergonié, Bordeaux, France.
authors.forename: Nadine
authors.initials: N
authors.lastname: Houédé
authors.affiliation: Department of Urology, Hôpital Henri Mondor, AP-HP, Créteil, France.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Vordos
authors.affiliation: Department of Cancer Medicine and INSERM U981, Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France.
authors.forename: Yohann
authors.initials: Y
authors.lastname: Loriot
authors.affiliation: Département d'Oncologie Médicale, Institut Claudius Regaud, IUCT-O, Toulouse, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Chevreau
authors.affiliation: Department of Medical Oncology, Centre François Baclesse, Caen, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sevin
authors.affiliation: Oncological Medicine, Institut Curie, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Beuzeboc
authors.affiliation: Inserm U955 Hôpital Henri Mondor, Team 7 Translational Research of Genito-Urinary Oncogenesis, Créteil, France; Department of Urology, Hôpital Henri Mondor, AP-HP, Créteil, France; Paris Est University, Créteil, France.
authors.forename: Alexandre de la
authors.initials: A
authors.lastname: Taille
authors.affiliation: CEpiA (Clinical Epidemiology and Ageing), Unit EA 4393, Paris Est University, Créteil, France; Public Health Department, Hôpital Henri-Mondor, AP-HP, Créteil, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Le Thuaut
authors.affiliation: Inserm U955 Hôpital Henri Mondor, Team 7 Translational Research of Genito-Urinary Oncogenesis, Créteil, France; Paris Est University, Créteil, France; Department of Pathology and Tissue Biobank Unit, Hôpital Henri Mondor, AP-HP, Créteil, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Allory
authors.affiliation: Department of Medical Oncology, Hôpital Saint-Louis, AP-HP, Paris, France; Paris Diderot University, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Culine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D002945:Cisplatin / Q000627:therapeutic use; D015653:Cystectomy; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D005602:France; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D014747:Vinblastine / Q000627:therapeutic use; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D014747:Vinblastine; D004317:Doxorubicin; D016190:Carboplatin; D002945:Cisplatin; D008727:Methotrexate; D000093542:Gemcitabine
keywords: Bladder carcinoma; Postoperative chemotherapy; Prognosis; Survivals; Urothelial carcinoma