High-Risk MIBC Patients Benefit Most from Adjuvant Chemo

MIBC patients benefit from adjuvant chemo, including those with positive lymph nodes and surgical margins after cystectomy.
MIBC patients benefit from adjuvant chemo, including those with positive lymph nodes and surgical margins after cystectomy.

Patients at highest risk for disease recurrence following cystectomy for muscle-invasive bladder (MIBC) cancer may derive the most benefit from adjuvant chemotherapy (ACT), according to a recent Canadian study. These patients include those with node-positive disease and positive surgical margins.

Christopher M. Booth, MD of Queen's University Cancer Research Institute in Kingston, Ontario, and colleagues conducted a population-based retrospective cohort study of 2,802 patients who underwent cystectomy for MIBC. Of these, 537 (19%) received ACT.

Patients who received ACT had better overall and cancer-specific survival than those who did not, but the effect of ACT was greater for patients with positive lymph nodes and positive surgical margins.

Compared with patients who did not receive ACT, ACT recipients with node-positive disease had a 44% decreased risk of death from any cause and a 40% decreased risk of cancer-related death, whereas those with node-negative disease had a 20% decreased risk of death from any cause and a 21% decreased risk of cancer-related death, Dr. Booth's team reported online ahead of print in BJU International

ACT recipients with positive surgical margins had a 55% decreased risk of death from any cause and a 60% decreased risk of cancer-related death, whereas those who had negative surgical margins had a 25% and 21% decreased risk of these outcomes, respectively.

“This information may be helpful for physician and patient decision-making,” the authors concluded. “The observation of differential relative effect should be evaluated in an individual patient-level meta-analysis from the relevant RCTs [randomized controlled trials] of ACT in bladder cancer.”

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