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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 and 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, Vol. 39, No. 2: pp. 443-451

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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.

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