Decreased Overall and Bladder Cancer–Specific Mortality with Adjuvant Chemotherapy After Radical Cystectomy: Multivariable Competing Risk Analysis

摘要: Abstract Adding chemotherapy to radical cystectomy (RC) may improve outcome. Neoadjuvant treatment is advocated by guidelines based on meta-analysis data but severely underused in clinical practice. Adjuvant of patients at risk could be an alternative. We analyzed a sample 798 who underwent RC between 1993 and 2011 for high-risk superficial or muscle-invasive urothelial undifferentiated bladder cancer, which 23% received adjuvant cisplatin-based %5 neoadjuvant chemotherapy. The use was independent predictor decreased overall mortality (hazard ratio [HR]: 0.50; 95% confidence interval [CI], 0.38–0.66; p =0.0321), it not associated with competing mortality. Similar figures were obtained when analyzing the number cisplatin-containing cycles administered restricting analysis lymph node–positive extravesical node–negative disease, suggesting mortality-reducing effect after adjusting several patient- tumor-related confounders. Future trials should directly compare concepts application candidates RC. Patient summary decrease cancer–specific (RC).