Adjuvant cisplatin-based combination chemotherapy for lymph node (LN)-positive urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC): a retrospective international study of more than 1500 patients
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Adjuvant cisplatin-based combination chemotherapy for lymph node (LN)-positive urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC): a retrospective international study of more than 1500 patients. / Lucca, Ilaria; Rouprêt, Morgan; Kluth, Luis; Rink, Michael; Tilki, Derya; Fajkovic, Harun; Kassouf, Wassim; Hofbauer, Sebastian L; de Martino, Michela; Karakiewicz, Pierre I; Briganti, Alberto; Trinh, Quoc-Dien; Seitz, Christian; Fritsche, Hans-Martin; Burger, Maximilian; Lotan, Yair; Kramer, Gero; Shariat, Shahrokh F; Klatte, Tobias.
in: BJU INT, Jahrgang 115, Nr. 5, 01.05.2015, S. 722-727.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Adjuvant cisplatin-based combination chemotherapy for lymph node (LN)-positive urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC): a retrospective international study of more than 1500 patients
AU - Lucca, Ilaria
AU - Rouprêt, Morgan
AU - Kluth, Luis
AU - Rink, Michael
AU - Tilki, Derya
AU - Fajkovic, Harun
AU - Kassouf, Wassim
AU - Hofbauer, Sebastian L
AU - de Martino, Michela
AU - Karakiewicz, Pierre I
AU - Briganti, Alberto
AU - Trinh, Quoc-Dien
AU - Seitz, Christian
AU - Fritsche, Hans-Martin
AU - Burger, Maximilian
AU - Lotan, Yair
AU - Kramer, Gero
AU - Shariat, Shahrokh F
AU - Klatte, Tobias
N1 - This article is protected by copyright. All rights reserved.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - OBJECTIVE: To compare outcomes of patients with lymph node-positive urothelial carcinoma of the bladder (UCB) treated with or without adjuvant cisplatin-based combination chemotherapy (AC) after radical cystectomy (RC).PATIENTS AND METHODS: We retrospectively analyzed 1,523 patients with lymph node-positive UCB, who underwent RC with bilateral pelvic lymph node dissection. All patients had no evidence of disease after RC. AC was administered within 3 months. Competing-risks models were applied to compare UCB-related mortality.RESULTS: Of the 1523 patients, 874 (57.4%) received AC. The cumulative 1-, 2- and 5-year UCB-related mortality rates for all patients were 16%, 36% and 56%, respectively. Administration of AC was associated with an 18% relative reduction in the risk of UCB-related death (SHR 0.82, p=0.005). The absolute reduction in mortality was 3.5% at 5 years. The positive effect of AC was detectable in patients ≤70 years, in women, in pT3-4 disease, and in those with a higher lymph node density and lymphovascular invasion. This study is limited by its retrospective and non-randomized design, selection bias, the absence of central pathologic review and lack in standardization of lymph node dissection and cisplatin-based protocols.CONCLUSION: AC seems to reduce UCB-related mortality in patients with lymph node-positive UBC after RC. Younger patients, women and those with high-risk features such as pT3-4 disease, a higher lymph node density and lymphovascular invasion appear to benefit most. Appropriately powered prospective randomized trials are necessary to confirm these findings.
AB - OBJECTIVE: To compare outcomes of patients with lymph node-positive urothelial carcinoma of the bladder (UCB) treated with or without adjuvant cisplatin-based combination chemotherapy (AC) after radical cystectomy (RC).PATIENTS AND METHODS: We retrospectively analyzed 1,523 patients with lymph node-positive UCB, who underwent RC with bilateral pelvic lymph node dissection. All patients had no evidence of disease after RC. AC was administered within 3 months. Competing-risks models were applied to compare UCB-related mortality.RESULTS: Of the 1523 patients, 874 (57.4%) received AC. The cumulative 1-, 2- and 5-year UCB-related mortality rates for all patients were 16%, 36% and 56%, respectively. Administration of AC was associated with an 18% relative reduction in the risk of UCB-related death (SHR 0.82, p=0.005). The absolute reduction in mortality was 3.5% at 5 years. The positive effect of AC was detectable in patients ≤70 years, in women, in pT3-4 disease, and in those with a higher lymph node density and lymphovascular invasion. This study is limited by its retrospective and non-randomized design, selection bias, the absence of central pathologic review and lack in standardization of lymph node dissection and cisplatin-based protocols.CONCLUSION: AC seems to reduce UCB-related mortality in patients with lymph node-positive UBC after RC. Younger patients, women and those with high-risk features such as pT3-4 disease, a higher lymph node density and lymphovascular invasion appear to benefit most. Appropriately powered prospective randomized trials are necessary to confirm these findings.
U2 - 10.1111/bju.12829
DO - 10.1111/bju.12829
M3 - SCORING: Journal article
C2 - 24905084
VL - 115
SP - 722
EP - 727
JO - BJU INT
JF - BJU INT
SN - 1464-4096
IS - 5
ER -