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Keywords:

  • urothelial bladder cancer;
  • perioperative chemotherapy;
  • adjuvant;
  • neoadjuvant;
  • pattern of use;
  • outcome

Objective

  • To review time-trends in the use of perioperative chemotherapy and its impact on oncological outcomes in patients with bladder urothelial cancer (UC) at a single tertiary institution.

Patients and Methods

  • Using electronic and paper medical records, 89 patients were identified who underwent radical cystectomy with or without perioperative chemotherapy between 2004 and 2011 at Austin Health in Melbourne, Australia.
  • Patient demographics, clinico-pathological characteristics and details of recurrence and death were assessed by retrospective chart review.
  • Survival analysis was carried out using the Kaplan Meier method, with the impact of predictors assessed using Cox proportional hazard models.

Results

  • The median (range) age of this cohort was 65 (37–84) years, and 66 (74%) patients were male. Pathologic features included 68 (76%) pure UC, 21 (24%) mixed UC and 84 (94%) high grade tumours.
  • On clinical staging, 63 (71%) patients had muscle-invasive bladder cancer (cT-stage ≥T2), of whom 11 (17%) received neoadjuvant chemotherapy, with an increasing trend in use over time.
  • Following radical cystectomy, pT-stage ≥T3 and/or node positive were identified in 35 (39%) patients, of whom 16 (46%) received adjuvant chemotherapy. In addition, five patients with stage pT2 received adjuvant chemotherapy.
  • Of the total cohort of patients, 31 (35%) suffered recurrences, and 33 died, 27 from urothelial carcinoma.
  • On multivariate analysis, after adjusting for age, pT-stage and pN-stage, perioperative chemotherapy was associated with a significantly lower risk of recurrence [relative risk (RR) 0.41, p < 0.05], but not death from cancer or all causes.

Conclusions

  • Perioperative chemotherapy, and in particular neoadjuvant chemotherapy, remains relatively under-utilised at our institution despite recent increases.
  • The significant reduction in the risk of recurrence following treatment with perioperative chemotherapy with radical cystectomy highlights the importance of multi-modality treatment in bladder UC.
  • Identifying barriers to more widespread implementation of perioperative chemotherapy is critical for enhancing outcomes in patients with bladder UC.