Survival Benefit Persists With Delayed Initiation of Adjuvant Chemotherapy Following Radical Cystectomy for Locally Advanced Bladder Cancer

OBJECTIVE To determine if delaying the initiation of adjuvant chemotherapy following radical cystectomy for locally advanced bladder cancer worsens overall survival. METHODS This is a retrospective cohort study utilizing the National Cancer Database from 2006 to 2013. We included treatment-naive patients who underwent radical cystectomy for muscle-invasive bladder cancer found to have locally advanced disease (pT3-T4 and/or pN+). Patients received no chemotherapy or multiagent adjuvant chemotherapy between 30 and 180 days following surgery. We used a multivariable Cox Regression to assess for differences in overall survival according to when patients initiated adjuvant chemotherapy. RESULTS We identified 3590 patients: 2581 received no chemotherapy and 1009 received multiagent adjuvant chemotherapy. Adjuvant chemotherapy began 31-60 days postsurgery in 538 patients, 61-90 days in 321 patients, and 91-180 days in 150 patients. Relative to patients who did not receive chemotherapy, adjuvant chemotherapy decreased mortality when started 31-60 days (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.52-0.69; P <.001), 61-90 days (HR, 0.62; 95% CI, 0.53-0.74; P <.001) , and 91-180 days following radical cystectomy (HR, 0.69; 95% CI, 0.55-0.87; P = .002). CONCLUSION Adjuvant chemotherapy offers a survival benefit when started up to 6 months after radical cystectomy in patients with high-risk disease who did not receive neoadjuvant chemotherapy. Patients who require delayed initiation of adjuvant chemotherapy can still benefit from treatment. (C) 2019 Elsevier Inc.