THE OUTCOME COMPARISON OF NEOADJUVNAT AND ADJUVANT GEMCITABINE–CISPLATIN CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER

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Abstract

Introduction

Radical cystectomy plus platinum-based perioperative chemotherapy is a standard treatment for patients with clinically localized muscle-invasive bladder cancer. The standard perioperative chemotherapy is M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin). There has been no prospective randomized trial that compare neoadjuvant and adjuvant chemotherapy for bladder cancer. And then, the efficacy of perioperative chemotherapy with gemcitabine–cisplatin (GC) has not been also clarified. We compared clinical outcomes between neoadjuvant and adjuvant chemotherapy in patients received GC.

Methods

We retrospectively reviewed the records of patients were planned to treat with radical cystectomy plus perioperative chemotherapy with GC from 2005 to 2010 at our institution. The eligible patients were diagnosed as clinical stage T2-4, N0-2, M0 bladder cancer. The primary outcome measure is recurrence-free survival (RFS).

Results

A total of 42 patients received perioperative chemotherapy with GC (25 neoadjuvants and 17 adjuvants). The median cycle number of GC between two groups was not statistically significant different. The median follow-up duration was 28.6 months. During the follow-up period, recurrence was observed in nine and three patients with neoadjuvant and adjuvant groups, respectively. The RFS rate at the median follow-up was 66.7 and 76.4% in neoadjuvant and adjuvant groups, respectively. No statistical difference in RFS at the median follow-up was observed between two groups (P = 0.124).

Conclusions

Form our result, there was no statistically significant difference in RFS between neoadjuvant and adjuvant GC chemotherapy for muscle-invasive bladder cancer. Our findings suggest the timing of perioperative chemotherapy is less important than whether or not a patient receives perioperative chemotherapy.

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