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2008 Annual Meeting Abstracts
The Benefit and Tolerability of Adjuvant Chemotherapy for Advanced Bladder Cancer
David Y.T. Chen1, Ismail R Saad1, Teodoro A Schellato2, Rosalia Viterbo1, Richard E Greenberg1, Robert G Uzzo1
1Fox Chase Cancer Center, Philadelphia, PA;2Albert Einstein Medical Center, Philadelphia, PA
Introduction: Surgery by radical cystectomy (RC) with lymph node (LN) dissection is standard therapy for muscle invasive bladder cancer (BC). Neoadjuvant chemotherapy followed by surgery improves survival over surgery alone. We aimed to examine the impact and tolerability of adjuvant chemotherapy (AC), whose benefit has been assumed but poorly defined.
Methods: We retrospectively reviewed records of 150 consecutive patients who underwent RC at our institution for invasive BC. We examined clinical parameters, pathologic findings, use of chemotherapy, and patient outcomes.
Results: Surgical results revealed significant clinical understaging: 63% of patients were upstaged; 83 patients (55%) were pathologically >T2 and 39 patients (26%) had positive LN metastases. Pathologic tumor stage, LN stage, total positive LN number and LN density were significantly correlated with outcome. Median follow-up was 13.6 months. AC was recommended to 58 patients, of whom 17 (29%) declined. 41 patients proceeded with AC, of which 27 (66%) completed the course. AC related mortality was 2% (1/41). In total, only 47% (27/58) of high-risk patients recommended for AC received full treatment; completion of AC appears to improve overall survival. (Figure)
Conclusions: AC shows a survival benefit for advanced BC, although most patients do not receive the full treatment. BC patients who do not complete AC have worse outcomes. Consideration should be made for neoadjuvant chemotherapy given the rate of pathologic upstaging and moderate AC completion rate. 
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