Top

Published in:

01-04-2018 | Original Article

Surgical treatment for clinical node-positive bladder cancer patients treated with radical cystectomy without neoadjuvant chemotherapy

Authors: Marco Moschini, Agostino Mattei, Julian Cornelius, Shahrokh F. Shariat, Paolo Dell’Oglio, Emanuele Zaffuto, Andrea Salonia, Francesco Montorsi, Alberto Briganti, Renzo Colombo, Andrea Gallina

Published in: World Journal of Urology | Issue 4/2018

Abstract

Objective

Growing literature supports good survival expectancies in bladder cancer (BCa) patients affected by clinical node metastases (cN+) treated with multimodal therapy. We evaluated the role of adjuvant chemotherapy in cN+BCa patients treated with radical cystectomy (RC) and pelvic lymph node dissection (PLND) without neoadjuvant chemotherapy (NAC).

Methods

We evaluated a total of 192 patients with BCa and cN+. All patients were treated with RC and PLND without NAC between 2001 and 2013. Kaplan–Meier analyses and Cox regression analyses were used to assess the impact of adjuvant chemotherapy (ACT) on recurrence, cancer-specific mortality (CSM) and overall mortality (OM) after surgery.

Results

Overall, 99 patients (51.6%) were found without node metastases at RC, while 18 (9.4%), 58 (30.2%) and 17 (8.9%) patients were found pN1, pN2 and pN3, respectively. With a median follow-up of 48 months, in cN+ patients we recorded 5-year recurrence, CSM and OM of 55, 53 and 51%, respectively. Overall, 36 (18.8%) patients were treated with adjuvant chemotherapy. At univariable analyses, ACT was associated with improved overall survival [Hazard ratio (HR): 0.42, confidence interval (CI) 0.20–0.86, p = 0.02) in pN+ subgroup only. These results were confirmed at multivariable analyses, where ACT was associated with improved CSS (HR: 0.45, CI 0.21–0.89, p = 0.03) and OS (HR: 0.37, CI 0.17–0.81, p = 0.01).

Conclusions

We report good survival outcomes in cN+ patients treated with RC. The use of ACT after surgery increases survival expectancies, especially in those patients with pathological node disease. Our data need to be further evaluated in prospective setting.

Alfred Witjes J, Lebret T, Compérat EM, Cowan NC, De Santis M, Bruins HM et al (2016) Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol. https://doi.org/10.1016/j.eururo.2016.06.020

Shariat SF, Karakiewicz PI, Palapattu GS, Lotan Y, Rogers CG, Amiel GE et al (2006) Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contemporary series from the Bladder Cancer Research Consortium. J Urol 176:2414–2422. https://doi.org/10.1016/j.juro.2006.08.004 (discussion 2422) CrossRefPubMed

Sun M, Abdollah F, Bianchi M, Trinh Q-D, Shariat SF, Jeldres C et al (2012) Conditional survival of patients with urothelial carcinoma of the urinary bladder treated with radical cystectomy. Eur J Cancer 48:1503–1511. https://doi.org/10.1016/j.ejca.2011.11.024 CrossRefPubMed

Moschini M, Karnes RJ, Sharma V, Gandaglia G, Fossati N, Dell’Oglio P et al (2016) Patterns and prognostic significance of clinical recurrences after radical cystectomy for bladder cancer: A 20-year single center experience. Eur J Surg Oncol 42(5):735–743. https://doi.org/10.1016/j.ejso.2016.02.011 CrossRefPubMed

Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 19:666–675CrossRefPubMed

Shariat SF, Palapattu GS, Karakiewicz PI, Rogers CG, Vazina A, Bastian PJ et al (2007) Discrepancy between clinical and pathologic stage: impact on prognosis after radical cystectomy. Eur Urol 51(1):137–149. https://doi.org/10.1016/j.eururo.2006.05.021 CrossRefPubMed

Moschini M, Morlacco A, Briganti A, Hu B, Colombo R, Montorsi F et al (2016) Clinical lymphadenopathy in urothelial cancer: a transatlantic collaboration on performance of cross-sectional imaging and oncologic outcomes in patients treated with radical cystectomy without neoadjuvant chemotherapy. Eur Urol Focus. https://doi.org/10.1016/j.euf.2016.11.005

Galsky MD, Stensland K, Sfakianos JP, Mehrazin R, Diefenbach M, Mohamed N et al (2016) Comparative effectiveness of treatment strategies for bladder cancer with clinical evidence of regional lymph node involvement. J Clin Oncol 34:2627–2635. https://doi.org/10.1200/JCO.2016.67.5033 CrossRefPubMedPubMedCentral

Ho PL, Willis DL, Patil J, Xiao L, Williams SB, Melquist JJ et al (2016) Outcome of patients with clinically node-positive bladder cancer undergoing consolidative surgery after preoperative chemotherapy: the M.D. Anderson Cancer Center Experience. Urol Oncol 34(59):1–8. https://doi.org/10.1016/j.urolonc.2015.08.012

10.

Zargar-Shoshtari K, Zargar H, Lotan Y, Shah JB, van Rhijn BW, Daneshmand S et al (2015) A multi-institutional analysis of outcomes in patients with clinically node positive urothelial bladder cancer treated with induction chemotherapy and radical cystectomy. J Urol. https://doi.org/10.1016/j.juro.2015.07.085 PubMedCentral

11.

Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL et al (2003) Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 349(9):859–866. https://doi.org/10.1056/nejmoa022148 CrossRefPubMed

12.

International Collaboration of Trialists, Medical Research Council Advanced Bladder Cancer Working Party (now the National Cancer Research Institute Bladder Cancer Clinical Studies Group), European Organisation for Research and Treatment of Cancer Genito-Urinary Tract Cancer Group, Australian Bladder Cancer Study Group, National Cancer Institute of Canada Clinical Trials Group, Finnbladder et al (2011) International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: long-term results of the BA06 30894 trial. J Clin Oncol 29:2171–2177. https://doi.org/10.1200/JCO.2010.32.3139 CrossRef

13.

Dorfman RE, Alpern MB, Gross BH, Sandler MA (1991) Upper abdominal lymph nodes: criteria for normal size determined with CT. Radiology 180:319–322. https://doi.org/10.1148/radiology.180.2.2068292 CrossRefPubMed

14.

Greene FL, Page DL, Fleming IDE (2002) Urinary bladder. In: AJCC Cancer Staging Manual. 6 (Edn) Springer, New York

15.

Shariat SF, Svatek RS, Tilki D, Skinner E, Karakiewicz PI, Capitanio U et al (2010) International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy. BJU Int 105:1402–1412. https://doi.org/10.1111/j.1464-410X.2010.09217.x CrossRefPubMed

16.

Novara G, Svatek RS, Karakiewicz PI, Skinner E, Ficarra V, Fradet Y et al (2010) Soft tissue surgical margin status is a powerful predictor of outcomes after radical cystectomy: a multicenter study of more than 4,400 patients. J Urol 183:2165–2170. https://doi.org/10.1016/j.juro.2010.02.021 CrossRefPubMed

17.

Daneshmand S, Ahmadi H, Huynh LN, Dobos N (2012) Preoperative staging of invasive bladder cancer with dynamic gadolinium-enhanced magnetic resonance imaging: results from a prospective study. Urology 80:1313–1318. https://doi.org/10.1016/j.urology.2012.07.056 CrossRefPubMed

18.

Moschini M, Jeffrey Karnes R, Gandaglia G, Luzzago S, Dell’Oglio P, Rossi MS et al (2016) Preoperative favorable characteristics in bladder cancer patients cannot substitute the necessity of extended lymphadenectomy during radical cystectomy: a sensitivity curve analysis. Urology 88:97–103. https://doi.org/10.1016/j.urology.2015.12.005 CrossRefPubMed

Title: Surgical treatment for clinical node-positive bladder cancer patients treated with radical cystectomy without neoadjuvant chemotherapy
Authors: Marco Moschini
Agostino Mattei
Julian Cornelius
Shahrokh F. Shariat
Paolo Dell’Oglio
Emanuele Zaffuto
Andrea Salonia
Francesco Montorsi
Alberto Briganti
Renzo Colombo
Andrea Gallina
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 4/2018
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2190-1

At a glance: The STEP trials

Springer Medicine

Surgical treatment for clinical node-positive bladder cancer patients treated with radical cystectomy without neoadjuvant chemotherapy

Abstract

Objective

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2018

Novel technology of molecular radio-guidance for lymph node dissection in recurrent prostate cancer by PSMA-ligands

Prostatic artery embolization for benign prostatic obstruction: assessment of safety and efficacy

Reply to letter to editor regarding: LHRH analog therapy is associated with worse metabolic side effects than bilateral orchiectomy in prostate cancer

Single-use flexible ureteropyeloscopy: a systematic review

68Ga-prostate specific membrane antigen (PSMA) positron emission tomography (PET) for primary staging of high-risk prostate cancer: a systematic review

Is the laser mightier than the sword? A comparative study for the urethrotomy