Effect of adjuvant chemotherapy in locally advanced urothelial carcinoma of the bladder treated with cystectomy
| Autor: | M.J. Cancho Gil, E. Lledó García, D. Subirá Ríos, F. Herranz Amo, J.A. Arranz Arija, C. Hernández Fernández, G. del Pozo Jiménez, J. Carballido Rodríguez, G. Bueno Chomón, E. Rodríguez Fernández |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Multivariate analysis Proportional hazards model business.industry medicine.medical_treatment 030232 urology & nephrology Urology General Medicine Cystectomy 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Cohort medicine Stage (cooking) business Lymph node Pathological Survival analysis |
| Zdroj: | Actas Urológicas Españolas (English Edition). 44:94-102 |
| ISSN: | 2173-5786 |
| DOI: | 10.1016/j.acuroe.2019.08.005 |
| Popis: | Introduction Currently, the role of adjuvant chemotherapy (ADJ) in muscle invasive bladder tumor (MIBC) remains controversial. Objective To evaluate the effect of ADJ on cancer specific survival (CSS) of MIBC after radical cystectomy (RC). Material and methods Retrospective analysis of 292 patients diagnosed with urothelial bladder tumor (BT) pT3-4pN0/+ cM0 stage, treated with RC between 1986-2009. Total cohort was divided in two groups: 185 (63.4%) patients treated with ADJ and 107 (36.6%) without ADJ. Median follow-up was 40.5 months (IQR 55–80.5). Comparative analysis was performed with Chi-square test and Student’s t test/ANOVA. Survival analysis was carried out with the Kaplan–Meier method and log-rank test. Multivariate analysis (Cox regression) was made to identify independent predictors of cancer-specific mortality (CSM). Results 42.8% of the series presented lymph node involvement after RC. At the end of follow-up, 22.9% were BC-free and 54.8% had died due to this cause. The median CSS was 30 months. No significant differences were observed in CSS regarding the treatment with ADJ in pT3pN0 (p = .25) or pT4pN0 (p = .29) patients, but it was significant in pT3-4pN+ (p = .001). Multivariate analysis showed pathological stage (p = .0001) and treatment with ADJ (p = .007) as independent prognostic factors for CSM. ADJ reduced the risk of CSM (HR:0.59,95%CI 0.40–0.87, p = .007). Conclusions pT and pN stages were identified as independent predictors of CSM after RC. The administration of ADJ in our series behaved as a protective factor reducing the risk of CSM, although only pN + patients were benefited in the stage analysis. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect