Neoadjuvant chemotherapy for invasive bladder cancer: Prognostic factors for survival of patients treated with M-VAC with 5-year follow-up Journal Article


Authors: Schultz, P. K.; Herr, H. W.; Zhang, Z. F.; Bajorin, D. F.; Seidman, A.; Sarkis, A.; Fair, W. R.; Scherr, D.; Bosl, G. J.; Scher, H. I.
Article Title: Neoadjuvant chemotherapy for invasive bladder cancer: Prognostic factors for survival of patients treated with M-VAC with 5-year follow-up
Abstract: Purpose: To determine survival in patients with muscle-invasive bladder cancer treated with neoadjuvant chemotherapy and to analyze prechemotherapy and postchemotherapy factors for prognostic significance. Patients and Methods: The survival of 111 patients with T2-4N0M0 bladder cancer treated with neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (M- VAC) was assessed. Prechemotherapy and postchemotherapy factors were analyzed for correlation with survival. Factors found to be significant on univariate analysis were subjected to multivariate analysis using Cox's proportional hazards model. Results: The median follow-up duration was 5.3 years. Initial tumor (T) stage (P = .0001), presence of ureteral obstruction (P = .0074), and presence of a palpable mass (P = .0039) were the only pretreatment factors found to be significant on univariate analysis. Postchemotherapy surgery was performed in 81 patients. In these cases, postchemotherapy clinical stage and pathologic stage were significant factors on univariate analysis. In the multivariate analysis, the initial prechemotherapy T stage and the postchemotherapy pathologic stage (pT stage) were the only two factors to demonstrate independent significance. An association between downstaging postchemotherapy and survival was observed for patients with extravesical disease (T ≤ 3B) at the start of treatment. In this subset, the 5-year survival rate was 54% for patients with downstaging versus 12% for those without downstaging. This association was not observed for patients with bladder-confined disease (T ≤ 3A) at presentation. Conclusion: The stage of bladder cancer at presentation and at postchemotherapy pathologic staging are independent prognostic factors for long-term survival in patients treated with neoadjuvant chemotherapy. Down-staging after neoadjuvant chemotherapy was associated with improved survival in patients with muscle- invasive bladder cancers, but only for those with extravesical disease (T ≥ 3B) pretreatment. Randomized comparisons will be required to assess the impact of chemotherapy on overall survival.
Keywords: adult; cancer chemotherapy; cancer survival; aged; survival rate; major clinical study; cisplatin; doxorubicin; cancer patient; methotrexate; cancer staging; follow up; bladder cancer; vinblastine; cancer invasion; patient compliance; multivariate analysis; ureter obstruction; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 12
Issue: 7
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 1994-07-01
Start Page: 1394
End Page: 1401
Language: English
DOI: 10.1200/jco.1994.12.7.1394
PROVIDER: scopus
PUBMED: 8021730
DOI/URL:
Notes: Source: Scopus
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MSK Authors
  1. Dean Bajorin
    419 Bajorin
  2. Andrew D Seidman
    255 Seidman
  3. Harry W Herr
    410 Herr
  4. Howard Scher
    841 Scher
  5. George Bosl
    274 Bosl
  6. William R Fair
    204 Fair
  7. Zuo-Feng Zhang
    96 Zhang
  8. Alvaro S. Sarkis
    27 Sarkis