Adjuvant cisplatin-based combined chemotherapy for lymph node (LN)-positive urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC): a retrospective international study of >1500 patients.

Details

Serval ID
serval:BIB_CD1E0840E9EA
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Adjuvant cisplatin-based combined chemotherapy for lymph node (LN)-positive urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC): a retrospective international study of >1500 patients.
Journal
Bju International
Author(s)
Lucca I., Rouprêt M., Kluth L., Rink M., Tilki D., Fajkovic H., Kassouf W., Hofbauer S.L., de Martino M., Karakiewicz P.I., Briganti A., Trinh Q.D., Seitz C., Fritsche H.M., Burger M., Lotan Y., Kramer G., Shariat S.F., Klatte T.
ISSN
1464-410X (Electronic)
ISSN-L
1464-4096
Publication state
Published
Issued date
2015
Peer-reviewed
Oui
Volume
115
Number
5
Pages
722-727
Language
english
Notes
Publication types: Journal Article Publication Status: ppublish
Abstract
OBJECTIVE: To compare outcomes of patients with lymph node (LN)-positive urothelial carcinoma of the bladder (UCB) treated with or without cisplatin-based combined adjuvant chemotherapy (AC) after radical cystectomy (RC).
PATIENTS AND METHODS: We retrospectively analysed 1523 patients with LN-positive UCB, who underwent RC with bilateral pelvic LN dissection. All patients had no evidence of disease after RC. AC was administered within 3 months. Competing-risks models were applied to compare UCB-related mortality.
RESULTS: Of the 1523 patients, 874 (57.4%) received AC. The cumulative 1-, 2- and 5-year UCB-related mortality rates for all patients were 16%, 36% and 56%, respectively. Administration of AC was associated with an 18% relative reduction in the risk of UCB-related death (subhazard ratio 0.82, P = 0.005). The absolute reduction in mortality was 3.5% at 5 years. The positive effect of AC was detectable in patients aged ≤70 years, in women, in pT3-4 disease, and in those with a higher LN density and lymphovascular invasion. This study is limited by its retrospective and non-randomised design, selection bias, the absence of central pathological review and lack in standardisation of LN dissection and cisplatin-based protocols.
CONCLUSION: AC seems to reduce UCB-related mortality in patients with LN-positive UCB after RC. Younger patients, women and those with high-risk features such as pT3-4 disease, a higher LN density and lymphovascular invasion appear to benefit most. Appropriately powered prospective randomised trials are necessary to confirm these findings.
Pubmed
Web of science
Open Access
Yes
Create date
18/05/2015 15:25
Last modification date
20/08/2019 15:47
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