Urothelial bladder cancer (UBC) with clinical suspicion of locally advanced growth or pelvic lymphogenic spread has a high risk of progression and death.
Bladder cancer patients with locally advanced (cT3/4) tumor growth or suspected pelvic lymphogenic spread (cN+) were treated with preoperative cisplatin-containing chemotherapy and consolidative cystectomy with pelvic lymphadenectomy.
We aimed to identify prognostic factors and describe the patients' oncological outcome.
A complete dataset including follow-up data was available for 96 patients. In a univariate analysis, we identified cN stage (cN+ vs cN-, HR 2.7, 95% CI 1.3-6.0), response to chemotherapy (HR 0.2, 95% CI 0.1-0.5), ypT stage (ypT0/is/1 vs ypT2-4, HR 3.1, 95% CI 1.4-6.8), ypN stage (ypN + vs ypN-, HR 7.9, 95% CI 3.7-17.0), resection status (HR 4.4, 95% CI HR 1.5-13.0) as significantly associated with cancer-specific survival. In a multivariate regression analysis, both cN and ypN statuses were validated as independent prognostic factors for cancer-specific survival (cN: HR 2.6, 95% CI 1.1-6.1; ypN: HR 5.5, 95% CI 2.0-15.1).
Lymph node status was identified as a prognostic marker in a high-risk cohort of UBC patients treated with inductive chemotherapy and cystectomy. Establishing cN status as a prognosticator underlines the necessity to aggressively treat these patients despite reported impreciseness of imaging procedures in UCB. Patients with histologically positive lymph nodes following preoperative chemotherapy have a very poor prognosis, and thus, the need for adjuvant systemic treatment is emphasized.
Both clinically and pathologically affected lymph nodes convey a poor prognosis in bladder cancer and necessitate aggressive treatment.
World journal of urology. 2022 Oct 21 [Epub ahead of print]
Julia Wagner, Ricarda Simon, Jakob Wolf Büchler, Florian Kirchhoff, Viktoria Kehl, Margitta Retz, Juergen Erich Gschwend, Andreas Sauter, Thomas Horn
Department of Urology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany., Institute for AI and Informatics in Medicine, Technical University of Munich, Munich, Germany., Institute for Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany., Department of Urology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany. .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/36269368