Neoadjuvant cisplatinum based combination chemotherapy in patients with invasive bladder cancer:: A combined analysis of two Nordic studies

被引:206
作者
Sherif, A [1 ]
Holmberg, L
Rintala, E
Mestad, O
Nilsson, J
Nilsson, S
Malmström, PU
机构
[1] Akad Univ Hosp, Dept Urol, SE-75185 Uppsala, Sweden
[2] Karolinska Hosp, Radiumhemmet, Dept Oncol, S-10401 Stockholm, Sweden
[3] Cent Hosp Rogaland, Urol Serv, Stavanger, Norway
[4] Helsinki Univ Hosp, Dept Urol, Helsinki, Finland
[5] Akad Univ Hosp, Dept Surg Sci, SE-75185 Uppsala, Sweden
[6] Akad Univ Hosp, Reg Oncol Ctr, SE-75185 Uppsala, Sweden
关键词
bladder cancer; cystectomy; neoadjuvant chemotherapy;
D O I
10.1016/j.eururo.2003.09.019
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Objectives: A Nordic collaborative group assessed the effectiveness of cisplatinum based combination chemotherapy prior to cystectomy in two consecutive trials. We analyzed overall survival in all patients and in prespecified subgroups defined by preoperative T-stage, gender and age. Methods: The studies included in 1985-1997 620 patients with clinically T1G3, T2-T4aNXM0 urothelial bladder cancer and WHO performance status less than or equal to 2. Platinum was combined with adriamycin in the first and with methotrexate in the second trial. In the first of the studies, preoperative radiotherapy was used in both arms. Individual patient data were used. No patients were lost to follow-up. The median follow-up was 4.7 years. A fixed effect model was used to combine the results of the two trials. Subgroup analyses were performed for T-stages, gender and age groups. All analyses were done according to intention to treat. Results: The combined study results showed a hazard ratio of 0.80 (95% confidence interval 0.64-0.99) for overall survival in favor of neoadjuvant treatment. Survival was 56% at five years in the experimental group versus 48% in the control group, thus corresponding to an eight percent absolute risk reduction after neoadjuvant chemotherapy. We could not substantiate any differences in effect by subgroup. Conclusions: In a combined analysis of two trials within the same study organization and the same clinical and biological domain, neoadjuvant platinum based combination chemotherapy was associated with a 20% reduction in the relative hazard in probability of death. (C) 2003 Elsevier B.V. All rights reserved.
引用
收藏
页码:297 / 303
页数:7
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