TY - JOUR
T1 - The impact of treatment modality on survival in patients with clinical node-positive bladder cancer
T2 - results from a multicenter collaboration
AU - the European Association of Urology-Young Academic Urologists (EAU-YAU), Urothelial Carcinoma Working Group
AU - Afferi, Luca
AU - Zamboni, Stefania
AU - Karnes, R. Jeffrey
AU - Roghmann, Florian
AU - Sargos, Paul
AU - Montorsi, Francesco
AU - Briganti, Alberto
AU - Gallina, Andrea
AU - Mattei, Agostino
AU - Schulz, Gerald Bastian
AU - Hendricksen, Kees
AU - Voskuilen, Charlotte S.
AU - Rink, Michael
AU - Poyet, Cedric
AU - De Cobelli, Ottavio
AU - di Trapani, Ettore
AU - Simeone, Claudio
AU - Soligo, Matteo
AU - Simone, Giuseppe
AU - Tuderti, Gabriele
AU - Alvarez-Maestro, Mario
AU - Martínez-Piñeiro, Luis
AU - Aziz, Atiqullah
AU - Shariat, Shahrokh F.
AU - Abufaraj, Mohammad
AU - Xylinas, Evanguelos
AU - Moschini, Marco
N1 - Publisher Copyright:
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2021/2
Y1 - 2021/2
N2 - Purpose: To assess the impact of perioperative chemotherapy on survival in cN+ BCa patients and analyze it according to the pN status. Methods: A retrospective analysis was conducted on 639 BCa patients with cTanyN1-3M0 BCa treated with radical cystectomy (RC) and bilateral lymph node dissection (LND) with or without perioperative chemotherapy in ten tertiary referral centers from 1990 to 2017. Selected cN+ patients received induction chemotherapy (IC), whereas adjuvant chemotherapy (ACT) was delivered to selected pN+ patients. Univariable and multivariable Cox regression analyses were used to predict overall mortality (OM) after surgery, adjusting for clinicopathological confounders. Kaplan–Meier analyses assessed OM according to the treatment modality. Results: Overall, 356 (56%) patients were treated with surgery alone, 155 (24%) with IC followed by surgery, and 128 (20%) with ACT following surgery. Over a median follow-up of 25 months, 316 deaths were recorded. At univariable analysis, patients treated with IC and surgery had lower OM both considering cN+ [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.49–0.87, p = 0.004] and cN+pN− patients (HR 0.61, 95% CI 0.37–0.99, p = 0.05) compared to those treated with surgery alone. cN+pN+ patients treated with ACT experienced lower OM compared to those treated with IC or surgery alone at multivariable analysis (HR 0.40, 95% CI 0.22–0.74, p = 0.003). Conclusion: Patients with cTany cN+ cM0 BCa benefit more in terms of OS when treated with IC followed by RC + LND compared to RC + LND alone, regardless of LNMs at final histopathology examination. More data are needed to assess the role of ACT in the management of cN+ patients.
AB - Purpose: To assess the impact of perioperative chemotherapy on survival in cN+ BCa patients and analyze it according to the pN status. Methods: A retrospective analysis was conducted on 639 BCa patients with cTanyN1-3M0 BCa treated with radical cystectomy (RC) and bilateral lymph node dissection (LND) with or without perioperative chemotherapy in ten tertiary referral centers from 1990 to 2017. Selected cN+ patients received induction chemotherapy (IC), whereas adjuvant chemotherapy (ACT) was delivered to selected pN+ patients. Univariable and multivariable Cox regression analyses were used to predict overall mortality (OM) after surgery, adjusting for clinicopathological confounders. Kaplan–Meier analyses assessed OM according to the treatment modality. Results: Overall, 356 (56%) patients were treated with surgery alone, 155 (24%) with IC followed by surgery, and 128 (20%) with ACT following surgery. Over a median follow-up of 25 months, 316 deaths were recorded. At univariable analysis, patients treated with IC and surgery had lower OM both considering cN+ [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.49–0.87, p = 0.004] and cN+pN− patients (HR 0.61, 95% CI 0.37–0.99, p = 0.05) compared to those treated with surgery alone. cN+pN+ patients treated with ACT experienced lower OM compared to those treated with IC or surgery alone at multivariable analysis (HR 0.40, 95% CI 0.22–0.74, p = 0.003). Conclusion: Patients with cTany cN+ cM0 BCa benefit more in terms of OS when treated with IC followed by RC + LND compared to RC + LND alone, regardless of LNMs at final histopathology examination. More data are needed to assess the role of ACT in the management of cN+ patients.
KW - Bladder cancer
KW - Clinical metastases
KW - Induction chemotherapy
KW - Multimodal treatment
KW - Radical cystectomy
KW - Urothelial cancer
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U2 - 10.1007/s00345-020-03205-z
DO - 10.1007/s00345-020-03205-z
M3 - Article
C2 - 32356226
AN - SCOPUS:85084201077
SN - 0724-4983
VL - 39
SP - 443
EP - 451
JO - World Journal of Urology
JF - World Journal of Urology
IS - 2
ER -