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J Cancer 2015; 6(8):750-758. doi:10.7150/jca.12259 This issue Cite

Research Paper

Adjuvant Chemotherapy Correlates with Improved Survival after Radical Cystectomy in Patients with pT3b (Macroscopic Perivesical Tissue Invasion) Bladder Cancer

Hyung Suk Kim^1*, Songzhe Piao^1,3*, Kyung Chul Moon², Chang Wook Jeong¹, Cheol Kwak¹, Hyeon Hoe Kim¹, Ja Hyeon Ku^{1 ✉}

1. Department of Urology, Seoul National University College of Medicine, Seoul, Korea
2. Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
3. Department of urology, Yanbian University Hospital, Yanji, Jilin Province, China
* Hyung Suk Kim and Songzhe Piao contributed equally to this work as a co-first author.

✉ Corresponding author: Ja Hyeon Ku, M.D. PhD., Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. Tel: 82-2-2072-0361; Fax: 82-2-742-4665; E-mail: kuuro70ac.kr

Abstract

Object: To elucidate the impact of adjuvant chemotherapy (ACH) on survival in patients with urothelial carcinoma of the bladder (UCB) diagnosed with pT3 disease (perivesical tissue invasion).

Methods: We reviewed the clinical data of 424 patients who underwent radical cystectomy (RC) with bilateral pelvic lymphadenectomy for UCB in our institution between 1991 and 2012. None of the patients received neoadjuvant chemotherapy. Of all patients, 101 (23.8%) were diagnosed with pT3 disease: pT3a in 43 patients and pT3b in 58 patients. The Kaplan-Meier method with the log-rank test was used to estimate and compare overall survival (OS) and cancer-specific survival (CSS) between groups. Multivariate Cox proportional hazard models were used to identify predictors of OS and CSS.

Results: Five-year OS (48.5% vs. 45.6%) and CSS (56.1% vs. 56.2%) were similar in the pT3a and pT3b groups (p = 0.658 and 0.840, respectively). In all pT3 patients, ACH administration was an independent predictor for OS (p = 0.018), but not CSS (p = 0.623) on multivariate analyses. On multivariate analysis according to the pT3 sub-stage, ACH was significantly associated with improved OS (hazard ratio [HR] 0.35; 95% confidence interval [CI] 0.17-0.72, p = 0.004) and CSS (HR 0.33; 95% CI 0.10-0.85, p = 0.022) in only the pT3b group.

Conclusion: Our data suggest that in pT3b disease, characterized by macroscopic perivesical tissue invasion, patients may obtain an OS benefit from the administration of ACH. Thus, our findings provide evidence for establishing appropriate indications for ACH in muscle invasive UCB.

Keywords: urothelial carcinoma, radical cystectomy, perivesical tissue invasion, adjuvant chemotherapy, survival

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