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Comparative Study
. 2019 Dec;37(12):877-885.
doi: 10.1016/j.urolonc.2019.06.022. Epub 2019 Aug 14.

Propensity-matched analysis of stage-specific efficacy of adjuvant chemotherapy for bladder cancer

Felix V Chen  1 , Tulay Koru-Sengul  2 , Feng Miao  3 , Joshua S Jue  1 , Mahmoud Alameddine  1 , Devina J Dave  4 , Sanoj Punnen  5 , Dipen J Parekh  5 , Chad R Ritch  5 , Mark L Gonzalgo  6
Affiliations
Comparative Study

Propensity-matched analysis of stage-specific efficacy of adjuvant chemotherapy for bladder cancer

Felix V Chen et al. Urol Oncol. 2019 Dec.

Abstract

Background: Contemporary randomized controlled trials exploring adjuvant chemotherapy (AC) for bladder cancer (BCa) have yielded inconsistent results due to premature termination and/or poor patient accrual.

Objective: To compare efficacy of AC vs. observation after radical cystectomy stratified by disease stage in a propensity-matched cohort.

Design, setting, and participants: We performed a retrospective study that included patients who underwent radical cystectomy for any pT, N0-1, M0 BCa from the National Cancer Data Base (2004-2014). Patients who underwent AC were 1:1 propensity matched with patients who received observation only.

Outcome measurements and statistical analysis: Overall survival was assessed with multivariable Cox regression models where adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated.

Results and limitations: After coarsened exact 1:1 propensity matching, 3,066 patients (AC 1,533; observation 1,533) were included in the analysis. There were no significant differences in patient-, facility-, or tumor-level characteristics among cohorts. Compared with patients who underwent observation, recipients of AC had improved overall survival (aHR 0.67; 95% CI 0.61-0.74). Patients with pT2-4, pN1 disease significantly benefited from AC. Among the pN0 cohort, improved survival from AC was observed only in stages pT3 (aHR 0.67; 95% CI 0.55-0.83) and pT4 (aHR 0.70; 95% CI 0.50-0.98).

Conclusions: AC was associated with improved survival in locally advanced (pT3-4, pN0) and regionally advanced (pT2-4, pN1) chemotherapy-naive BCa.

Keywords: Adjuvant chemotherapy; Bladder cancer; National Cancer Data Base; Perioperative chemotherapy.

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Figures

Fig. 1.
Fig. 1.
Study cohort flow diagram.
Fig. 2.
Fig. 2.
Forest plot of impact of adjuvant chemotherapy (AC) on overall survival in disease subgroups. CI = confidence interval; HR = hazard ratio; Obs = observation.
Fig. 3.
Fig. 3.
Adjusted survival curves according to tumor stage and use of chemotherapy: (A–C) no nodal metastasis; (D–F) nodal metastasis. Obs = observation; AC = adjuvant chemotherapy.
See this image and copyright information in PMC

References

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