The role of adjuvant chemotherapy in patients with locally advanced (pT3, pT4a) and/or lymph node-positive bladder cancer.

OBJECTIVE: To report the long-term follow up of patients with locally advanced bladder cancer treated with either adjuvant chemotherapy with gemcitabine/cisplatin (GC) or methotrexate, vinblastine, epirubicin, and cisplatin (MVEC) or no additional treatment after radical cystectomy, to examine various survival endpoints and factors associated with long-term survival. PATIENTS AND METHODS: Seventy-eight patients undergoing radical cystectomy for pathologic stage T3, T4 or lymph node-positive (N+) bladder cancer were divided to observation group (46 patients) and adjuvant chemotherapy group (32 patients). Data were obtained for recurrence free (RFS) and overall survival (OS).
RESULTS: One-, 2- and 5-year RFS rates were 74, 56.8 and 51.1% for chemotherapy arm, whereas these ratios were 50.6, 31 and 27.6% for control arm, respectively (P = 0.032). RFS rates were significantly better in patients with lymph node-negative disease than in those with positive lymph nodes for control arm (P = 0.007), but for the chemotherapy arm there was no statistical difference between patients with lymph node-negative and -positive disease (P = 0.28). Mean OS and RFS times were 31.03 and 28.4 months for chemotherapy arm, while they were 22.17 and 18.09 months for control arm, respectively (P = 0.142, P = 0.196). On multivariate analysis, lymph node metastasis and adjuvant chemotherapy remained significant independent prognostic factors for cancer-specific survival.
CONCLUSIONS: Bladder cancer is chemosensitive, and using adjuvant chemotherapy is likely to improve the outcome of local treatment and to decrease the rates of distant metastases.