Adjuvant chemotherapy after cystectomy may prolong survival

A retrospective study of patients seen at the University of Chicago suggests that adjuvant chemotherapy is an essential part of the treatment protocol for lymph node-positive bladder cancer.

Looking back at 67 node-positive patients who underwent radical cystectomy between 1995 and 2005, researchers found that those who also had combined adjuvant chemotherapy fared significantly better in both disease-free and overall survival.

"The differences in disease-free and overall survival were so remarkable that we believe these data are sufficient to use in counseling patients," said lead study author Gary D. Steinberg, MD.

Co-author Mark Katz, MD, agreed with Dr. Steinberg, but added that "because this is a retrospective study, a future, multi-institutional, randomized trial would help corroborate our findings."

All patients had lymph node-positive bladder cancer (26 with stage pN1, 41 with stage pN2). Following surgery, 35 of the 67 (52%) agreed to chemotherapy. Most (28) received a combination of gemcitabine (Gemzar) and cisplatin (Platinol), while the others received alternate combinations. The remaining 32 patients declined further treatment.

The two study groups were fairly similar in postoperative complication rate and N stage, although deferring patients were, on average, 5 years older and had a more advanced T stage.

Among those who accepted chemotherapy, it was well tolerated, with 28 of 35 patients (80%) completing all four cycles.

The median overall survival for patients given adjuvant chemotherapy was 48 months, compared with just 8 months for those who declined (pp<.0001). Disease-free survival was 34 months for the adjuvant chemotherapy group and 6 months for those who deferred (p<.0001).