Propensity-matched analysis of stage-specific efficacy of adjuvant chemotherapy for bladder cancer

• Published in: Urologic oncology 2019-12, Vol.37 (12), p.877-885
• Main Authors: Chen, Felix V., Koru-Sengul, Tulay, Miao, Feng, Jue, Joshua S., Alameddine, Mahmoud, Dave, Devina J., Punnen, Sanoj, Parekh, Dipen J., Ritch, Chad R., Gonzalgo, Mark L.
• Format: Article
• Language: English
• Subjects: Adjuvant chemotherapy; Bladder cancer; National Cancer Data Base; Perioperative chemotherapy
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2019.06.022

•Adjuvant chemotherapy improves survival in all node-positive disease (pT2-4, pN1).•Adjuvant chemotherapy improves survival in some node-negative disease (pT3-4, pN0).•Adjuvant chemotherapy did not significantly improve survival in pT2, pN0 disease. Contemporary randomized controlled trials exploring adjuvant chemotherapy (AC) for bladder cancer (BCa) have yielded inconsistent results due to premature termination and/or poor patient accrual. To compare efficacy of AC vs. observation after radical cystectomy stratified by disease stage in a propensity-matched cohort. We performed a retrospective study that included patients who underwent radical cystectomy for any pT, N0-1, M0 BCa from the National Cancer Data Base (2004–2014). Patients who underwent AC were 1:1 propensity matched with patients who received observation only. Overall survival was assessed with multivariable Cox regression models where adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated. After coarsened exact 1:1 propensity matching, 3,066 patients (AC 1,533; observation 1,533) were included in the analysis. There were no significant differences in patient-, facility-, or tumor-level characteristics among cohorts. Compared with patients who underwent observation, recipients of AC had improved overall survival (aHR 0.67; 95% CI 0.61–0.74). Patients with pT2-4, pN1 disease significantly benefited from AC. Among the pN0 cohort, improved survival from AC was observed only in stages pT3 (aHR 0.67; 95% CI 0.55–0.83) and pT4 (aHR 0.70; 95% CI 0.50–0.98). AC was associated with improved survival in locally advanced (pT3-4, pN0) and regionally advanced (pT2-4, pN1) chemotherapy-naive BCa.