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Muscle-invasive transitional cell carcinoma of the bladder is a highly aggressive neoplasm, with a relatively high systemic failure rate despite effective local therapy (radical cystectomy or radiotherapy). Neoadjuvant cisplatin-based combination chemotherapy can modestly improve survival of patients undergoing radical cystectomy (Cochrane Database Syst Rev 2005; 2:CD005246). Unlike neoadjuvant therapy, for which statistically robust trials have been completed, studies of benefits from chemotherapy in the adjuvant setting have been inconclusive.
To better understand the value of adjuvant chemotherapy, investigators conducted a retrospective analysis of an international cohort of 3947 patients who underwent radical cystectomy without neoadjuv…