Adjuvant Chemotherapy Lowers Bladder Cancer Death Risk

Cisplatin-based chemotherapy after radical cystectomy for high-risk bladder cancer decreased the risk of death from the malignancy by 29%.
Cisplatin-based chemotherapy after radical cystectomy for high-risk bladder cancer decreased the risk of death from the malignancy by 29%.

Adjuvant chemotherapy after radical cystectomy (RC) for high-risk bladder cancer may decrease overall and cancer-specific mortality, according to investigators.

Michael Fröhner, MD, of Technischen Universität Dresden, and colleagues studied 798 patients who underwent RC for high-risk superficial or muscle-invasive urothelial or undifferentiated bladder cancer from 1993 to 2011. Of these, 23% received adjuvant cisplatin-based chemotherapy and 5% received neoadjuvant chemotherapy. The use of adjuvant chemotherapy was associated with a significant 50% decreased risk of overall mortality and 29% decreased risk of bladder-cancer specific mortality.

Patients who received adjuvant chemotherapy were significantly younger than those who did not (66 vs. 68 years). They also were healthier, with 31% of recipients having a Charlson score of 2 or higher compared with 40% of patients who did not receive adjuvant chemotherapy.

“Although patients who received adjuvant chemotherapy were somewhat younger and/or healthier, the consistent identification of adjuvant chemotherapy as an independent predictor of reduced mortality in various models may most likely be explained, at least in part, by a true treatment effect,” the researchers wrote in a paper published online ahead of print in European Urology. “These observations support the concept of offering adjuvant chemotherapy to high-risk patients after RC, particularly since they were made in a largely unselected sample with a meaningful proportion of patients who were unfit or unwilling to undergo chemotherapy.”

The study builds on other investigations that have demonstrated survival benefits associated with post-RC adjuvant chemotherapy. In a study 2,044 patients who underwent RC for muscle-invasive bladder cancer, Canadian researchers led by Christopher M. Booth, MD, of Queen's University in Kingston, Ontario, found that adjuvant chemotherapy was associated with a 29% decreased risk of all-cause mortality and 27% decreased risk of death from bladder cancer, according to a report in Cancer (2014;120:1630-1638). In separate study of 746 patients who underwent RC for bladder cancer, Taekmin Kwon, MD, and colleagues at Asan Medical Center in Seoul, Korea, showed that patients who received adjuvant chemotherapy had a significant 44% decreased risk of dying from bladder cancer than those who did not, according to findings published in the Journal of Cancer Research and Clinical Oncology (2015;141:169-176). Patients who received adjuvant chemotherapy were significantly younger 60 vs. 63 years) and more likely to have adverse pathologic features.

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