Management and outcome of muscle-invasive bladder cancer with clinical lymph node metastases. A nationwide population-based study in the bladder cancer data base Sweden (BladderBaSe)

Complete metabolic response with [18F]fluorodeoxyglucose‐positron emission tomography/computed tomography predicts survival following induction chemotherapy and radical cystectomy in clinically lymph node positive bladder cancer

“…The 4-year CSS rate was relatively high at 60% in the present population-based cohort comprising LN-positive patients. This can be explained primarily by selection mechanisms in a cohort of younger patients without significant comorbidities that excluded both non-responders and patients with distant metastasis detected by FDG-PET-CT. With this in mind, the present findings do support the increase of 10-25% in the use of chemotherapy and RC in selected patients with bladder cancer and locoregional LN metastases that have occurred over the last few years in Sweden [8]. Furthermore, given the higher rates of objective response to checkpoint inhibitors seen in patients that only have LN metastases compared to those with other metastatic locations [20], it is plausible that second-line treatment at an earlier stage can further improve survival in non-responding patients [21] with this historically under-acknowledged disease [22].…”

“…Such an approach could also spare non-responders unnecessary toxicity and surgery, and instead offer second-line treatment with checkpoint inhibition. Today, only a small proportion of patients with LN-positive disease receive such multimodal treatment [8]. Repeated FDG-PET-CT-examinations have previously provided promising results in monitoring of histological response to induction chemotherapy in LNpositive and oligometastatic bladder cancer [9,10].…”

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

“…BCa patients with clinical lymph node metastasis are often treated with systemic CHT and have a poor prognosis [5,6 ▪ ,7]. Several studies point out the advantage of a multimodal approach consisting of CHT followed by RC [6 ▪ ,8 ▪ ,26 ▪ ,27,28 ▪ ]. In a systematic review of literature, we showed that despite the heterogeneity of treatment protocols in patients with metastatic BCa, surgical intervention after measurable response to induction CHT provides survival benefits in well-selected patients [19].…”

“…Similar results have been reported by Stanik et al [8 ▪ ], in which combination therapy comprising of perioperative chemotherapy and RC had a better 5-year OS rate than isolated surgery or CHT. In addition, Aljabery et al [27] demonstrated superior survival outcomes in multimodal therapy as compared with CHT or RC alone.…”

Association Between the Pretreatment Albumin-to-Alkaline Phosphatase Ratio and Clinical Outcomes in Patients With Bladder Cancer Treated With Radical Cystectomy: A Retrospective Cohort Study

“…About 50% of high-risk patients will have distant metastasis and the 5-year survival rate is only 40%-60% (5). Some clinicopathological characteristics have been shown to be closely associated with adverse outcomes, such as advanced stage (6), lymph node metastasis (7), poor differentiation (8), and anemia (9). However, patients with similar features to one another often have different clinical outcomes.…”