Poor prognosis of bladder cancer patients with occult lymph node metastases treated with neoadjuvant chemotherapy Journal Article


Authors: Cha, E. K.; Sfakianos, J. P.; Sukhu, R.; Yee, A. M.; Sjoberg, D. D.; Bochner, B. H.
Article Title: Poor prognosis of bladder cancer patients with occult lymph node metastases treated with neoadjuvant chemotherapy
Abstract: Objectives: To characterise the outcomes of neoadjuvant chemotherapy (NAC) pre-treated patients found to be lymph node (LN)-positive at the time of radical cystectomy and pelvic lymph node dissection (RC/PLND) for urothelial carcinoma of the bladder (UCB). Patients and Methods: Of 1484 patients treated with RC/PLND for UCB from 2000 to 2010, we analysed 198 patients with clinically non-metastatic (cN0M0) muscle-invasive UCB who were found to be LN-positive at RC/PLND. As patients not receiving perioperative chemotherapy were significantly older and comorbid, we compared LN-positive patients previously treated with NAC (32 patients) to LN-positive patients treated with adjuvant chemotherapy (AC, 49 patients) using Cox proportional hazards models. A sensitivity analysis was designed to account for the additional time to RC in NAC patients. Results: The 3-year recurrence-free survival estimate for LN-positive NAC patients was 26%, compared with 60% for LN-positive AC patients. LN-positive patients treated with NAC had significantly higher risks of disease recurrence and cancer-specific mortality in univariate analyses (hazard ratio [HR] 2.86, 95% confidence interval [CI] 1.58–5.19, P = 0.001 and HR 2.50, 95% CI 1.34–4.65, P = 0.004, respectively) and multivariable analyses adjusting for pathological stage and LN density (HR 3.11, 95% CI 1.59–6.07, P = 0.001 and HR 3.05, 95% CI 1.46–6.35, P = 0.003, respectively). Sensitivity analyses similarly demonstrated worse outcomes for NAC pre-treated LN-positive patients. Conclusion: LN-positive patients previously treated with NAC have a poor prognosis, significantly worse than LN-positive patients subsequently treated with AC, and should be considered for protocols using sandwich chemotherapy approaches or novel agents. These results should be considered in the interpretation of and stratification for clinical trials. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd
Keywords: lymph node metastasis; lymph nodes; radical cystectomy; neoadjuvant chemotherapy; #bcsm; #bladdercancer
Journal Title: BJU International
Volume: 122
Issue: 4
ISSN: 1464-4096
Publisher: Wiley Blackwell  
Date Published: 2018-10-01
Start Page: 627
End Page: 632
Language: English
DOI: 10.1111/bju.14242
PROVIDER: scopus
PUBMED: 29633530
PMCID: PMC7899171
DOI/URL:
Notes: Article -- Export Date: 1 November 2018 -- Source: Scopus
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
  1. Daniel D. Sjoberg
    234 Sjoberg
  2. Bernard Bochner
    470 Bochner
  3. Alyssa Mae Yee
    3 Yee
  4. Eugene K. Cha
    100 Cha
  5. Ranjit   Sukhu
    6 Sukhu