Comparative effectiveness of palliative chemotherapy versus neoadjuvant chemotherapy followed by radical cystectomy versus cystectomy followed by adjuvant chemotherapy versus cystectomy for regional node‐positive bladder cancer: A retrospective analysis: KCSG GU 17‐03

Abstract

The regional lymph node‐positive bladder cancer was classified as stage IV in the AJCC 7th edition but was changed to stage IIIB in the 8th edition, revised in 2018. Among the various studies involving immune checkpoint inhibitors, groups that had only lymph node metastasis showed better outcomes than those with distant metastasis. Therefore, it is necessary to rethink the treatment strategy for lymph node‐positive bladder cancer. The aim of this study was to compare the treatment outcomes of chemotherapy, surgery, and combination therapy in patients with lymph node‐positive bladder cancer. From 1 January 2010 to 31 December 2015, patients with bladder cancer presenting local lymph node metastasis at the time of diagnosis were treated with a single treatment strategy, with either radical cystectomy or chemotherapy or with a combined strategy using both. Treatment outcomes were retrospectively analyzed on the basis of clinical indices and survival time. Out of 230 patients with bladder cancer, 44 (19.1%) were treated with palliative chemotherapy, 30 (13.0%) with neoadjuvant chemotherapy followed by cystectomy, 129 (56.1%) with cystectomy followed by adjuvant chemotherapy, and 27 (11.7%) with cystectomy alone. Median survival among all groups was 30.4 months. For each group, median overall survival was 19.3, 49.1, 42.6, and 11.2 months, respectively. This study represents an advancement in understanding the impact of clinical treatment patterns of lymph node‐positive bladder cancer through comparison of survival data of patients treated with different therapeutic strategies. Combined treatment resulted in better outcomes than did single treatments.

Surgical intervention in patients with urothelial carcinoma of the bladder and lymph node metastasis

“…Moreover, NAC was associated with downstaging at each clinical nodal status in comparison with upfront RC. A significant improvement in OS in both NAC and ACT was demonstrated by Bae et al [12 ▪ ]. They reported better OS outcomes for combination therapy compared with single therapy modalities in 230 patients (49.1 months for NAC, and 42.6% for ACT).…”

“…Such an approach is based on the rationale that the addition of systemic therapy to surgical resection can provide better control of subclinical lymph node involvement and micro-metastasis, which could theoretically improve systemic control and survival outcomes [8 ▪ ]. However, the net effect of preoperative chemotherapy in patients with lymph node involvement has not been well elucidated, with some studies demonstrating a survival benefit [9 ▪ ,11,12 ▪ ], while others are showing a worse prognosis [13,14 ▪ ].…”

A risk score for the prognosis prediction of the muscle-invasive bladder cancer patients who received gemcitabine plus cisplatin chemotherapy

“…As a result, clinicians adopt adjuvant chemotherapy (AC) after RC as an alternative. Wosnitzer MS et al [ 21 ], Matsubara N et al [ 22 ], and Bae WK et al [ 23 ] all concluded no statistically significant difference between NAC and AC, while Bene G Del et al [ 24 ] found that NAC was superior to AC in terms of disease-free survival (DFS). According to Berg et al, the survival effect of AC was only seen in individuals with pure urothelial carcinoma [ 25 ].…”

Clinical Characteristics, Treatment Delivery, and Cisplatin Eligibility in Korean Patients Initially Diagnosed with Urothelial Carcinoma

“…The classification categories were adopted to organize all types of UC, including both UTUC and bladder UC, according to the actual treatment application. Patient with bladder UC with clinically lymph node involvement (cN+) showed effectiveness in curative combined-modality therapy of cystectomy and perioperative chemotherapy compared to palliative chemotherapy [22,23]. The regional lymph node-positive bladder cancer was previously classified as stage IV in the American Joint Committee on Cancer 7th edition but was changed to stage IIIB in the revised 8th edition in 2018.…”