Occult lymph node metastases in patients with carcinoma invading bladder muscle: incidence after neoadjuvant chemotherapy and cystectomy vs after cystectomy alone

Abstract

Objective• To investigate the effect of neoadjuvant chemotherapy (NAC) on the incidence of lymph node (LN) metastases in clinically node-negative (cN0) patients with carcinoma invading the bladder muscle (MIBC). Patients and Methods• Between 1990 and 2012, 828 consecutive patients underwent radical cystectomy (RC) with extended pelvic LN dissection (ePLND), of whom 441 had cT2-4N0M0 stage disease. • A total of 83 patients received NAC then underwent RC and 358 patients underwent RC only. The ePLND template and the indication for NAC remained the same during the study period.• The incidence of occult LN metastases was compared between the groups. Unadjusted and adjusted odds ratios (ORs) were calculated to investigate the influence of NAC, cT stage, gender and the preoperative staging technique used (computed tomography [CT] or positron emission tomography/CT) on the occurrence of LN metastases.• Overall survival (OS) and disease-specific survival were analysed using the Kaplan-Meier method. Results• Patients in the NAC group more often had locally advanced MIBC than patients in the non-NAC group (cT3-4: 88.0 vs 30.2%). In the NAC group, 19.3% of patients had LN metastases vs 28.5% of the patients in the non-NAC group (P = 0.099). In the patients with cT3-4 disease, the occurrence of LN metastases was significantly lower in the NAC group than in the non-NAC group (21.9 vs 40.7%, respectively, P = 0.002).• In multivariable analysis, adjusting for cT stage, gender and staging method, NAC was independently associated with a lower likelihood of LN metastases (OR: 0.41, 95% CI 0.21-0.79; P = 0.008).• Among the patients with cT3-4 disease, the median OS was significantly longer in the NAC group than in the non-NAC group (68.0 vs 23.0 months, P = 0.047) Conclusion• These data suggest that, along with a downstaging effect on the primary bladder tumour, NAC is associated with a lower incidence of occult LN metastases at the time of RC.

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

“…The median (interquartile range [IQR]) age of our cohort at time of RC was 64 (57-71) years. The median (IQR) number of positive LNs was 2 (1-5), with a median (IQR) number of LNs removed of 20 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). These clinicopathological characteristics were similar in the NAC and AC groups.…”

“…Further, although studies have identified that pathological responders to NAC have better outcomes than non-responders, the comparison of NAC non-responders with chemotherapy-na€ ıve non-responders has not been well characterised [19]. Another study reported on the incidence of LN metastases in clinically non-metastatic patients comparing those treated with NAC vs RC alone, but focused on the effect of NAC upon the likelihood of LN metastases rather than the outcomes of the 16 LN-positive NAC patients [20].…”

A Radiomics Nomogram for the Preoperative Prediction of Lymph Node Metastasis in Bladder Cancer

“…Therefore, neoadjuvant chemotherapy has not been performed regularly (22). Moreover, because neoadjuvant chemotherapy targets micrometastasis (including LN metastasis), patients with LN metastases are likely to benefit from this therapy (23).…”

Improving the outcome of patients with muscle invasive urothelial carcinoma of the bladder with neoadjuvant gemcitabine/cisplatin chemotherapy: A single institution experience

“…This is similar to a recently reported single institution study examining ypN status in patients undergoing an extended pelvic lymph node dissection post-NAC. 22 Survival in the present series is related to the absence or presence of lymph node metastases, which is also correlated with clinical stage. NAC did not have a meaningful impact on survival for patients with pN+ disease, but it is possible that NAC down-staged patients such that the incidence of pN+ disease is reduced which contributes to the improvement in survival observed with NAC.…”