Damien Pouessel1, Sylvie Bastuji-Garin2, Nadine Houédé3, Dimitri Vordos4, Yohann Loriot5, Christine Chevreau6, Emmanuel Sevin7, Philippe Beuzeboc8, Alexandre de la Taille9, Aurélie Le Thuaut2, Yves Allory10, Stéphane Culine11. 1. 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. 2. CEpiA (Clinical Epidemiology and Ageing), Unit EA 4393, Paris Est University, Créteil, France; Public Health Department, Hôpital Henri-Mondor, AP-HP, Créteil, France. 3. Department of Medical Oncology, Institut Bergonié, Bordeaux, France. 4. Department of Urology, Hôpital Henri Mondor, AP-HP, Créteil, France. 5. Department of Cancer Medicine and INSERM U981, Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France. 6. Département d'Oncologie Médicale, Institut Claudius Regaud, IUCT-O, Toulouse, France. 7. Department of Medical Oncology, Centre François Baclesse, Caen, France. 8. Oncological Medicine, Institut Curie, Paris, France. 9. 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. 10. 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. 11. Department of Medical Oncology, Hôpital Saint-Louis, AP-HP, Paris, France; Paris Diderot University, Paris, France.
Abstract
BACKGROUND: 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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
BACKGROUND: 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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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: Robert H Press; Joseph W Shelton; Chao Zhang; Quang Dang; Sibo Tian; Timothy Shu; Crystal S Seldon; Shaakir Hasan; Ashesh B Jani; Jun Zhou; Mark W McDonald Journal: Int J Part Ther Date: 2021-07-06