GENITOURINARY GROUP PHASE-II STUDY OF CHEMOTHERAPY IN STAGE T3-4 N0-XM0 TRANSITIONAL-CELL CANCER OF THE BLADDER - PROGNOSTIC FACTOR-ANALYSIS

The aim of this study was to examine prognostic factors for survival o f patients with invasive bladder cancer who had received neoadjuvant c hemotherapy followed by further treatment. From 1986 to 1990, 149 elig ible patients with T3-4 N0-X M0 bladder cancer were entered into a pha se II trial of neoadjuvant chemotherapy, consisting of cisplatin and m ethotrexate. Patients received two or four courses of chemotherapy, de pending on the absence or presence, respectively, of a major clinical response after two courses. 136 patients were evaluable for clinical r esponse after two courses of chemotherapy, and 75 patients were evalua ble for pathological response after two or four courses. A multivariat e analysis, based on pretreatment variables and the post-treatment var iables, clinical response and pathological response, showed that perfo rmance status, tumour size and clinical response after two courses of chemotherapy were the only independent prognostic factors for all elig ible patients. A second multivariate analysis in the selected subgroup of patients, who underwent a cystectomy, showed that the G-cagetory a nd pathological response were the only independent prognostic factors. In conclusion, in this group of patients, the response to chemotherap y was a strong and independent prognostic factor in addition to other independent variables. However, it was not accurate or strong enough t o allow an impact on the choice of locoregional therapy. Copyright (C) 1996 Elsevier Science Ltd