Propensity-matched analysis of stage-specific efficacy of adjuvant chemotherapy for bladder cancer

Felix V. Chen, Tulay Sengul, Feng Miao, Joshua S. Jue, Mahmoud Alameddine, Devina J. Dave, Sanoj Punnen, Dipen J Parekh, Chad Ritch, Mark L Gonzalgo

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Abstract

Background: Contemporary randomized controlled trials exploring adjuvant chemotherapy (AC) for bladder cancer (BCa) have yielded inconsistent results due to premature termination and/or poor patient accrual. Objective: To compare efficacy of AC vs. observation after radical cystectomy stratified by disease stage in a propensity-matched cohort. Design, setting, and participants: We performed a retrospective study that included patients who underwent radical cystectomy for any pT, N0-1, M0 BCa from the National Cancer Data Base (2004–2014). Patients who underwent AC were 1:1 propensity matched with patients who received observation only. Outcome measurements and statistical analysis: Overall survival was assessed with multivariable Cox regression models where adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated. Results and limitations: After coarsened exact 1:1 propensity matching, 3,066 patients (AC 1,533; observation 1,533) were included in the analysis. There were no significant differences in patient-, facility-, or tumor-level characteristics among cohorts. Compared with patients who underwent observation, recipients of AC had improved overall survival (aHR 0.67; 95% CI 0.61–0.74). Patients with pT2-4, pN1 disease significantly benefited from AC. Among the pN0 cohort, improved survival from AC was observed only in stages pT3 (aHR 0.67; 95% CI 0.55–0.83) and pT4 (aHR 0.70; 95% CI 0.50–0.98). Conclusions: AC was associated with improved survival in locally advanced (pT3-4, pN0) and regionally advanced (pT2-4, pN1) chemotherapy-naive BCa.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - Jan 1 2019

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Adjuvant Chemotherapy
Urinary Bladder Neoplasms
Observation
Confidence Intervals
Cystectomy
Survival
Survival Analysis
Proportional Hazards Models
Neoplasms
Randomized Controlled Trials
Retrospective Studies
Databases
Drug Therapy

Keywords

  • Adjuvant chemotherapy
  • Bladder cancer
  • National Cancer Data Base
  • Perioperative chemotherapy

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

@article{b00f1d01b0c1448caeabd4c2d52c3b6f,
title = "Propensity-matched analysis of stage-specific efficacy of adjuvant chemotherapy for bladder cancer",
abstract = "Background: Contemporary randomized controlled trials exploring adjuvant chemotherapy (AC) for bladder cancer (BCa) have yielded inconsistent results due to premature termination and/or poor patient accrual. Objective: To compare efficacy of AC vs. observation after radical cystectomy stratified by disease stage in a propensity-matched cohort. Design, setting, and participants: We performed a retrospective study that included patients who underwent radical cystectomy for any pT, N0-1, M0 BCa from the National Cancer Data Base (2004–2014). Patients who underwent AC were 1:1 propensity matched with patients who received observation only. Outcome measurements and statistical analysis: Overall survival was assessed with multivariable Cox regression models where adjusted hazard ratios (aHR) and 95{\%} confidence intervals (95{\%} CI) were calculated. Results and limitations: After coarsened exact 1:1 propensity matching, 3,066 patients (AC 1,533; observation 1,533) were included in the analysis. There were no significant differences in patient-, facility-, or tumor-level characteristics among cohorts. Compared with patients who underwent observation, recipients of AC had improved overall survival (aHR 0.67; 95{\%} CI 0.61–0.74). Patients with pT2-4, pN1 disease significantly benefited from AC. Among the pN0 cohort, improved survival from AC was observed only in stages pT3 (aHR 0.67; 95{\%} CI 0.55–0.83) and pT4 (aHR 0.70; 95{\%} CI 0.50–0.98). Conclusions: AC was associated with improved survival in locally advanced (pT3-4, pN0) and regionally advanced (pT2-4, pN1) chemotherapy-naive BCa.",
keywords = "Adjuvant chemotherapy, Bladder cancer, National Cancer Data Base, Perioperative chemotherapy",
author = "Chen, {Felix V.} and Tulay Sengul and Feng Miao and Jue, {Joshua S.} and Mahmoud Alameddine and Dave, {Devina J.} and Sanoj Punnen and Parekh, {Dipen J} and Chad Ritch and Gonzalgo, {Mark L}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.urolonc.2019.06.022",
language = "English (US)",
journal = "Urologic Oncology: Seminars and Original Investigations",
issn = "1078-1439",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Propensity-matched analysis of stage-specific efficacy of adjuvant chemotherapy for bladder cancer

AU - Chen, Felix V.

AU - Sengul, Tulay

AU - Miao, Feng

AU - Jue, Joshua S.

AU - Alameddine, Mahmoud

AU - Dave, Devina J.

AU - Punnen, Sanoj

AU - Parekh, Dipen J

AU - Ritch, Chad

AU - Gonzalgo, Mark L

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Contemporary randomized controlled trials exploring adjuvant chemotherapy (AC) for bladder cancer (BCa) have yielded inconsistent results due to premature termination and/or poor patient accrual. Objective: To compare efficacy of AC vs. observation after radical cystectomy stratified by disease stage in a propensity-matched cohort. Design, setting, and participants: We performed a retrospective study that included patients who underwent radical cystectomy for any pT, N0-1, M0 BCa from the National Cancer Data Base (2004–2014). Patients who underwent AC were 1:1 propensity matched with patients who received observation only. Outcome measurements and statistical analysis: Overall survival was assessed with multivariable Cox regression models where adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated. Results and limitations: After coarsened exact 1:1 propensity matching, 3,066 patients (AC 1,533; observation 1,533) were included in the analysis. There were no significant differences in patient-, facility-, or tumor-level characteristics among cohorts. Compared with patients who underwent observation, recipients of AC had improved overall survival (aHR 0.67; 95% CI 0.61–0.74). Patients with pT2-4, pN1 disease significantly benefited from AC. Among the pN0 cohort, improved survival from AC was observed only in stages pT3 (aHR 0.67; 95% CI 0.55–0.83) and pT4 (aHR 0.70; 95% CI 0.50–0.98). Conclusions: AC was associated with improved survival in locally advanced (pT3-4, pN0) and regionally advanced (pT2-4, pN1) chemotherapy-naive BCa.

AB - Background: Contemporary randomized controlled trials exploring adjuvant chemotherapy (AC) for bladder cancer (BCa) have yielded inconsistent results due to premature termination and/or poor patient accrual. Objective: To compare efficacy of AC vs. observation after radical cystectomy stratified by disease stage in a propensity-matched cohort. Design, setting, and participants: We performed a retrospective study that included patients who underwent radical cystectomy for any pT, N0-1, M0 BCa from the National Cancer Data Base (2004–2014). Patients who underwent AC were 1:1 propensity matched with patients who received observation only. Outcome measurements and statistical analysis: Overall survival was assessed with multivariable Cox regression models where adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated. Results and limitations: After coarsened exact 1:1 propensity matching, 3,066 patients (AC 1,533; observation 1,533) were included in the analysis. There were no significant differences in patient-, facility-, or tumor-level characteristics among cohorts. Compared with patients who underwent observation, recipients of AC had improved overall survival (aHR 0.67; 95% CI 0.61–0.74). Patients with pT2-4, pN1 disease significantly benefited from AC. Among the pN0 cohort, improved survival from AC was observed only in stages pT3 (aHR 0.67; 95% CI 0.55–0.83) and pT4 (aHR 0.70; 95% CI 0.50–0.98). Conclusions: AC was associated with improved survival in locally advanced (pT3-4, pN0) and regionally advanced (pT2-4, pN1) chemotherapy-naive BCa.

KW - Adjuvant chemotherapy

KW - Bladder cancer

KW - National Cancer Data Base

KW - Perioperative chemotherapy

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U2 - 10.1016/j.urolonc.2019.06.022

DO - 10.1016/j.urolonc.2019.06.022

M3 - Article

C2 - 31420159

AN - SCOPUS:85070537950

JO - Urologic Oncology: Seminars and Original Investigations

JF - Urologic Oncology: Seminars and Original Investigations

SN - 1078-1439

ER -