The impact of treatment modality on survival in patients with clinical node-positive bladder cancer: results from a multicenter collaboration

Afferi, Luca; Zamboni, Stefania; Karnes, R. Jeffrey; Roghmann, Florian; Sargos, Paul; Montorsi, Francesco; Briganti, Alberto; Gallina, Andrea; Mattei, Agostino; Schulz, Gerald Bastian; Hendricksen, Kees; Voskuilen, Charlotte S.; Rink, Michael; Poyet, Cedric; De Cobelli, Ottavio; di Trapani, Ettore; Simeone, Claudio; Soligo, Matteo; Simone, Giuseppe; Tuderti, Gabriele; Alvarez-Maestro, Mario; Martinez-Pineiro, Luis; Aziz, Atiqullah; Shariat, Shahrokh F.; Abufaraj, Mohammad; Xylinas, Evanguelos und Moschini, Marco (2020): The impact of treatment modality on survival in patients with clinical node-positive bladder cancer: results from a multicenter collaboration. In: World Journal of Urology, Bd. 39, Nr. 2: S. 443-451

Abstract

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.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0724-4983
• Sprache: Englisch