Malte W Vetterlein1, Thomas Seisen2, Matthias May3, Philipp Nuhn4, Michael Gierth5, Roman Mayr5, Hans-Martin Fritsche5, Maximilian Burger5, Vladimir Novotny6, Michael Froehner6, Manfred P Wirth6, Chris Protzel7, Oliver W Hakenberg7, Florian Roghmann8, Rein-Jüri Palisaar8, Joachim Noldus8, Armin Pycha9, Patrick J Bastian10, Quoc-Dien Trinh11, Evanguelos Xylinas12, Shahrokh F Shariat13, Michael Rink14, Felix K-H Chun14, Roland Dahlem14, Margit Fisch14, Atiqullah Aziz15. 1. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 2. Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, Pitié-Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France. 3. Department of Urology, St. Elisabeth Medical Center, Straubing, Germany. 4. Department of Urology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany. 5. Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany. 6. Department of Urology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany. 7. Department of Urology, University Medical Center Rostock, Rostock, Germany. 8. Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany. 9. Department of Urology, Central Hospital of Bolzano, Bolzano, Italy. 10. Department of Urology, Marien Hospital Düsseldorf, Düsseldorf, Germany. 11. Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 12. Department of Urology, Cochin Hospital, Descartes University, Paris, France. 13. Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria. 14. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 15. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: a.aziz@uke.de.
Abstract
BACKGROUND: The benefit of adjuvant chemotherapy (AC) for muscle-invasive urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC) is controversial. OBJECTIVE: To assess the effectiveness of AC after RC for muscle-invasive UCB in contemporary European routine practice. DESIGN, SETTING, AND PARTICIPANTS: By using a prospectively collected European multicenter database, we compared survival outcomes between patients who received AC versus observation after RC for locally advanced (pT3/T4) and/or pelvic lymph node-positive (pN+) muscle-invasive UCB in 2011. INTERVENTION: AC versus observation after RC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Inverse probability of treatment weighting (IPTW)-adjusted Cox regression and competing risks analyses were performed to compare overall survival (OS) as well as cancer-specific and other-cause mortality between patients who received AC versus observation. RESULTS AND LIMITATIONS: Overall, 224 patients who received AC (n = 84) versus observation (n = 140) were included. The rate of 3-yr OS in patients who received AC versus observation was 62.1% versus 40.9%, respectively (p = 0.014). In IPTW-adjusted Cox regression analysis, AC versus observation was associated with an OS benefit (hazard ratio: 0.47; 95% confidence interval [CI]: 0.25-0.86; p = 0.014). In IPTW-adjusted competing risks analysis, AC versus observation was associated with a decreased risk of cancer-specific mortality (subhazard ratio: 0.51; 95% CI: 0.26-0.98; p = 0.044) without any increased risk of other-cause mortality (subhazard ratio: 0.48; 95% CI: 0.14-1.60; p = 0.233). Limitations include the relatively small sample size as well as the potential presence of unmeasured confounders related to the observational study design. CONCLUSIONS: We found that AC versus observation was associated with a survival benefit after RC in patients with pT3/T4 and/or pN+ UCB. These results should encourage physicians to deliver AC and researchers to pursue prospective or large observational investigations. PATIENT SUMMARY: Overall survival and cancer-specific survival benefit was found in patients who received adjuvant chemotherapy relative to observation after radical cystectomy for locally advanced and/or pelvic lymph node-positive bladder cancer.
BACKGROUND: The benefit of adjuvant chemotherapy (AC) for muscle-invasive urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC) is controversial. OBJECTIVE: To assess the effectiveness of AC after RC for muscle-invasive UCB in contemporary European routine practice. DESIGN, SETTING, AND PARTICIPANTS: By using a prospectively collected European multicenter database, we compared survival outcomes between patients who received AC versus observation after RC for locally advanced (pT3/T4) and/or pelvic lymph node-positive (pN+) muscle-invasive UCB in 2011. INTERVENTION: AC versus observation after RC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Inverse probability of treatment weighting (IPTW)-adjusted Cox regression and competing risks analyses were performed to compare overall survival (OS) as well as cancer-specific and other-cause mortality between patients who received AC versus observation. RESULTS AND LIMITATIONS: Overall, 224 patients who received AC (n = 84) versus observation (n = 140) were included. The rate of 3-yr OS in patients who received AC versus observation was 62.1% versus 40.9%, respectively (p = 0.014). In IPTW-adjusted Cox regression analysis, AC versus observation was associated with an OS benefit (hazard ratio: 0.47; 95% confidence interval [CI]: 0.25-0.86; p = 0.014). In IPTW-adjusted competing risks analysis, AC versus observation was associated with a decreased risk of cancer-specific mortality (subhazard ratio: 0.51; 95% CI: 0.26-0.98; p = 0.044) without any increased risk of other-cause mortality (subhazard ratio: 0.48; 95% CI: 0.14-1.60; p = 0.233). Limitations include the relatively small sample size as well as the potential presence of unmeasured confounders related to the observational study design. CONCLUSIONS: We found that AC versus observation was associated with a survival benefit after RC in patients with pT3/T4 and/or pN+ UCB. These results should encourage physicians to deliver AC and researchers to pursue prospective or large observational investigations. PATIENT SUMMARY: Overall survival and cancer-specific survival benefit was found in patients who received adjuvant chemotherapy relative to observation after radical cystectomy for locally advanced and/or pelvic lymph node-positive bladder cancer.
Authors: Giuseppe Rosiello; Angela Pecoraro; Carlotta Palumbo; Sophie Knipper; Stefano Luzzago; Marina Deuker; Zhe Tian; Giorgio Gandaglia; Nicola Fossati; Francesco Montorsi; Shahrokh F Shariat; Fred Saad; Alberto Briganti; Pierre I Karakiewicz Journal: World J Urol Date: 2020-05-18 Impact factor: 4.226
Authors: Francesco Chierigo; Marco Borghesi; Christoph Würnschimmel; Rocco S Flammia; Benedikt Horlemann; Gabriele Sorce; Benedikt Hoeh; Zhe Tian; Fred Saad; Markus Graefen; Michele Gallucci; Alberto Briganti; Francesco Montorsi; Felix K H Chun; Shahrokh F Shariat; Guglielmo Mantica; Nazareno Suardi; Carlo Terrone; Pierre I Karakiewicz Journal: Prostate Date: 2022-02-28 Impact factor: 4.012