Carboplatin-based adjuvant chemotherapy versus observation after radical cystectomy in patients with pN1-3 urothelial bladder cancer.

To test the impact of carboplatin-based ACT on overall survival (OS) in patients with pN1-3 cM0 BCa. A retrospective analysis was conducted on 1057 patients with pTany pN1-3 cM0 urothelial BCa treated with or without carboplatin-based ACT after radical cystectomy and bilateral lymph-node dissection between 2002 and 2018 at 12 European and North-American hospitals. No patient received neoadjuvant chemotherapy or radiation therapy. Only patients with negative surgical margins at surgery were included. A 3:1 propensity score matching (PSM) was performed using logistic regression to adjust for baseline characteristics. Univariable and multivariable Cox regression analyses were used to predict the effect of carboplatin-based ACT on OS. The Kaplan-Meier method was used to display OS in the matched cohort. Of the 1057 patients included in the study, 69 (6.5%) received carboplatin-based ACT. After PSM, 244 total patients were identified in two cohorts that did not differ for baseline characteristics. Death was recorded in 114 (46.7%) patients over a median follow-up of 19 months. In the multivariable Cox regression analyses, increasing age at surgery (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.01-1.06, p < 0.001) and increasing number of positive lymph nodes (HR 1.06, 95% CI 1.01-1.07, p = 0.02) were independent predictors of worse OS. The delivery of carboplatin-based ACT was not predictive of improved OS (HR 0.67, 95% CI 0.43-1.04, p = 0.08). The main limitations of this study are its retrospective design and the relatively low number of patients involved. Carboplatin-based might not improve OS in patients with pN1-3 cM0 BCa. Our results underline the need for alternative therapies for cisplatin-ineligible patients. © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Citation

Luca Afferi, Chiara Lonati, Francesco Montorsi, Alberto Briganti, Andrea Necchi, Andrea Mari, Andrea Minervini, Riccardo Campi, Ettore di Trapani, Ottavio de Cobelli, R Jeffrey Karnes, Mohamed Ahmed, M Carmen Mir, Maria Asuncion Algarra, Michael Rink, Stefania Zamboni, Claudio Simeone, Wojciech Krajewski, Evanguelos Xylinas, Francesco Soria, Kees Hendricksen, Sarah Einerhand, Agostino Mattei, Roberto Carando, Mathieu Roumiguié, Anne Sophie Bajeot, Peter C Black, Shahrokh F Shariat, Marco Moschini, European Association of Urology-Young Academic Urologists (EAU-YAU), Urothelial carcinoma working group. Carboplatin-based adjuvant chemotherapy versus observation after radical cystectomy in patients with pN1-3 urothelial bladder cancer. World journal of urology. 2022 Jun;40(6):1489-1496

Mesh Tags

Substances

PMID: 35142865

search → result