OBJECTIVE: To investigate the influence of neoadjuvant chemotherapy (NAC) on the incidence of lymph node (LN) metastases in clinically node-negative (cN0) patients with muscle invasive bladder cancer (MIBC).
PATIENTS AND METHODS: Between 1990-2012, 828 consecutive patients underwent radical cystectomy (RC) with extended pelvic lymph node dissection (ePLND) , of them 441 were staged cT2-4N0M0. Eighty-three patients received NAC followed by RC and 358 underwent RC only. The ePLND template and the indication for NAC remained the same during the study period. The incidence of occult lymph node metastases in both groups was compared. Unadjusted and adjusted odds ratios (OR) were calculated to investigate the influence of NAC, cT-stage, gender and the preoperative staging modality used (CT or PET/CT) on the occurrence of LN metastases. Overall (OS) and disease specific survival (DSS) were analysed using the Kaplan-Meier method.
RESULTS: Patients in the NAC-group had more often locally advanced MIBC than patients in the non-NAC group (cT3-4: 88.0% versus 30.2%). Of the NAC patients, 19.3% had LN metastases versus 28.5% of the non-NAC patients (p=0.099). In the cT3-4 patients, the occurrence of LN metastases was significantly lower in the NAC group compared with the non-NAC group (21.9% versus 40.7%, respectively, p=0.002). In multivariable analysis, adjusting for cT-stage, gender and staging method, NAC was independently associated with a decreased likelihood of LN metastases (OR: 0.41, 95% CI 0.21-0.79; p=0.008). Among the cT3-4 patients, median OS was significantly longer in the NAC group versus the non-NAC group (68.0 versus 23.0 months, p=0.047).
CONCLUSION: These data suggest that, next to a downstaging effect on the primary bladder tumour, NAC is also associated with reduced incidence of occult LN metastases at the time of RC.
Written by:
Mertens LS, Meijer RP, Meinhardt W, van der Poel HG, Bex A, Kerst JM, van der Heijden MS, Bergman AM, Horenblas S, van Rhijn BW. Are you the author?
Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Reference: BJU Int. 2013 Sep 5. Epub ahead of print.
doi: 10.1111/bju.12447
PubMed Abstract
PMID: 24053889
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