Adjuvant Chemo Ups Survival in Locally Advanced Bladder Cancer
Improved survival with adjuvant chemotherapy in patients with locally advanced disease compared with cystectomy alone.
(HealthDay News) -- For patients with locally advanced bladder cancer, cystectomy plus adjuvant chemotherapy is associated with improved survival versus cystectomy alone, according to a study published online in the Journal of Clinical Oncology.
Matthew D. Galsky, MD, from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues compared the effectiveness of adjuvant chemotherapy versus observation postcystectomy in 5,653 patients with pathologic T3-4 and/or pathologic node-positive bladder cancer. Propensity score analysis based on patient-, facility-, and tumor-level characteristics were used to compare overall survival.
The researchers found that 23% of patients received adjuvant chemotherapy postcystectomy. Patients who received chemotherapy were younger and more likely to have private insurance, live in areas with higher median income and higher percentage of high school-educated residents, and have involvement of lymph nodes and positive surgical margins (all P < 0.05). In propensity score-matched analyses, adjuvant chemotherapy was associated with an improvement in overall survival (hazard ratio, 0.70); results were similar with propensity score matching and weighting. The correlation persisted in subset analyses and was robust to the effects of poor performance status.
"Although neoadjuvant chemotherapy remains the preferred approach based on level I evidence, these data lend further support for the use of adjuvant chemotherapy in patients with locally advanced bladder cancer postcystectomy who did not receive chemotherapy preoperatively," the authors write.
Two authors disclosed financial ties to the biopharmaceutical industry.
- Galsky MD, Stensland KD, Moshier K, et al. Effectiveness of Adjuvant Chemotherapy for Locally Advanced Bladder Cancer. JCO. doi:10.1200/JCO.2015.64.1076.
- Pal SK, Agarwal N, Grivas P, Choueiri T. Adjuvant Chemotherapy for Bladder Cancer: Using Population-Based Data to Fill a Void of Prospective Evidence. JCO. doi: 10.1200/JCO.2015.65.4368.