Adjuvant chemotherapy was associated with improved survival in patients with locally advanced bladder cancer, according to an observational study published online ahead of print in the Journal of Clinical Oncology.1
Because randomized trials evaluating adjuvant chemotherapy for bladder cancer have been underpowered and/or terminated early, leading to inconsistent results and unclear evidence, researchers sought to compare the effectiveness of cystectomy with cystectomy plus adjuvant chemotherapy in real-world patients.
For the observational study, researchers analyzed data from 5653 patients with pathologic T3-4 and/or pathologic node-positive bladder cancer from the National Cancer Data Base. Of those, 23% received adjuvant chemotherapy following bladder removal.
Results showed that adjuvant chemotherapy was associated with improved overall survival compared with cystectomy alone (HR, 0.70; 95% CI: 0.64-0.76). Subgroups analyses demonstrated consistent association between survival and adjuvant treatment.
Researchers also found that chemotherapy-treated patients were younger and more likely to have private insurance, live in areas with a higher median income and higher proportion of high school-educated residents, and have lymph node involvement and positive surgical margins (P<.05).
“Although neoadjuvant chemotherapy remains the preferred approach based on level 1 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 conclude.
1. Galsky MD, Stensland KD, Moshier E, et al. Effectiveness of adjuvant chemotherapy for locally advanced bladder cancer [published online ahead of print January 19, 2016]. J Clin Oncol. doi:10.1200/JCO.2015.64.1076.