Presentation Authors: Matteo Soligo*, Alessandro Morlacco, Michele Colicchia, Padova, Italy, Luca Boeri, Vidit Sharma, Igor Frank, Steven Boorjian, R. Jeffrey Karnes, Rochester, MN
Introduction: Adjuvant chemotherapy (AC) is recommended in patients with pT3-4 and/or pN1-3 bladder cancer after radical cystectomy (RC). However, its benefit on survival outcomes is still controversial. The aims of this study were: to discover whether AC may improve survival in these patients; to identify the most effective AC regimens and any predictors of CSS and OS.
Methods: We identified 996 patients with pT3-4 and/or pN1-3 disease at RCperformed at a tertiary referral center between 1998-2017. Exclusion criteria were: incomplete data; non-urothelial histology at RC. Patients were grouped as follow: 1) optimal AC (OAC): cisplatin-based AC for >3 cycles; 2) suboptimal AC (SAC): cisplatin-based AC for < 3 cycles or non cisplatin-based AC; 3) no AC. Propensity score matching by age, sex, neoadjuvant chemotherapy, pT, pN, eGFR and post-operative ECOG selected 92, 53 and 104 patients respectively. Descriptive statistics were used to show baseline data. Kaplan-Meyer curves and log-rank tests were used to compare CSS and OS between AC regimens. Multivariable Cox regression analysis was used to identify any predictors of CSS and OS.
Results: Matching variables were balanced between groups, except for positive pN status (OAC vs SAC vs no AC: 62, 67.4% vs 38, 71.7% vs 32, 30.8%) and post-operative eGFR (67.6 vs 58.5 vs 66.3 ml/min, p.021). No difference was found in the median time to recurrence (OAC vs SAC vs no AC: 9.7 vs 11.2 vs 11.1 months, p.828), median follow-up time (26.1 vs 29.2 vs 30.3 months, p.49) and all-cause deaths (58, 63% vs 40, 75.5% vs 72, 69.2%, p.29). Cancer-specific deaths were higher in the SAC group (46, 50% vs 37, 63.8% vs 52, 50%, p.037). Kaplan-Meier curves did not demonstrate an association between AC regimens and OS, CSS, PFS. At multivariable analysis, no significant predictor of PFS was found. Higher age at RC (HR 1.03, p.005), neoadjuvant chemotherapy (HR 2.1, p.007), pT3-4 (HR 2.72, p < .0001), pN1-3 (HR 1.97, p.001), lymphovascular invasion (HR 1.57, p.022) were associated to shorter CSS. Only OAC (HR .61, p.022) was significantly associated with longer CSS.
Conclusions: Despite the poor prognosis associated to pT3-4 and/or pN1-3 disease, OAC may improve survival outcomes after RC in selected fit patients, though it may not affect progression.