Occult Pelvic Lymph Node Involvement in Bladder Cancer: Implications for Definitive Radiation

Goldsmith, Benjamin; Baumann, Brian C.; He, Jiwei; Tucker, Kai; Bekelman, Justin E.; Deville, Curtiland; Vapiwala, Neha; Vaughn, David J.; Keefe, Stephen Michael; Guzzo, Thomas J.; Malkowicz, S. Bruce; Christodouleas, John P.

doi:10.1016/j.ijrobp.2013.11.211

Cited by 34 publications

(22 citation statements)

References 17 publications

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“…Preoperative risk stratification is a major challenge in bladder cancer (BC), and a robust biomarker is needed . One emerging candidate is the neutrophil‐to‐lymphocyte ratio (NLR).…”

Section: Introductionmentioning

confidence: 99%

Neutrophil‐to‐lymphocyte ratio as a bladder cancer biomarker: Assessing prognostic and predictive value in SWOG 8710

Ojerholm

Smith

Hwang

et al. 2016

Cancer

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Background Risk stratification is a major challenge in bladder cancer (BC), and a biomarker is needed. Multiple studies report the neutrophil-to-lymphocyte ratio (NLR) as a promising candidate; however, these analyses have methodological limitations. Therefore, we performed a category B biomarker study. We tested whether NLR is prognostic for overall survival (OS) after curative treatment or predictive for the benefit from neoadjuvant chemotherapy (NAC). Methods We performed a secondary analysis of SWOG 8710—a randomized, phase III trial that assessed cystectomy ± NAC in 317 patients with muscle-invasive BC. We calculated NLR from prospectively collected complete blood counts. We identified 230 patients for the prognostic analysis and 263 for the predictive analysis. We evaluated NLR using proportional hazards models including pre-specified factors (age, gender, T-stage, lymphovascular invasion, treatment arm). Results With a median follow-up of 18.6 years, there were 172 and 205 deaths in the prognostic and predictive cohorts, respectively. On multivariable analysis, NLR was not prognostic for OS (HR 1.04, 95%CI [0.98–1.11], P=0.24). Furthermore, NLR did not predict for the OS benefit from NAC (HR 1.01, 95%CI [0.90 – 1.14], P=0.86). Factors associated with worse OS were older age (HR 1.05, 95%CI [1.04–1.07], P<0.001) and surgery without NAC (HR 1.39, 95%CI [1.03–1.88], P=0.03). Conclusion This is the first analysis of NLR in BC to use prospectively collected clinical trial data. In contrast to previous studies, it suggests NLR is neither a prognostic nor predictive biomarker for OS in muscle-invasive BC. Trial Registration clinicaltrials.gov Identifier NCT02756637 https://clinicaltrials.gov/show/NCT02756637

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“…Preoperative risk stratification is a major challenge in bladder cancer (BC), and a robust biomarker is needed . One emerging candidate is the neutrophil‐to‐lymphocyte ratio (NLR).…”

Section: Introductionmentioning

confidence: 99%

Neutrophil‐to‐lymphocyte ratio as a bladder cancer biomarker: Assessing prognostic and predictive value in SWOG 8710

Ojerholm

Smith

Hwang

et al. 2016

Cancer

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“…The rationale for including pelvic lymph nodes in the initial portion of the radiation treatment field relates to the relatively high rate of occult lymph node involvement in regions typically targeted with pelvic radiotherapy, (33) and the finding that extensive lymphadenectomy at the time of radical cystectomy improves survival, suggesting that treatment of these lymph nodes has therapeutic efficacy. (34) The rationale for not specifically targeting pelvic lymph nodes includes improving tolerability of therapy by excluding more normal tissue from the treatment volume and the low rate of nodal failure when not specifically targeted.…”

Section: Discussionmentioning

confidence: 99%

Trimodality Therapy in Bladder Cancer

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Apolo

Agarwal

et al. 2015

Urologic Clinics of North America

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Summary Radical cystectomy is a standard treatment for non-metastatic, muscle-invasive bladder cancer. Treatment with trimodality therapy consisting of maximal transurethral resection of the bladder tumor (TURBT) followed by concurrent chemotherapy and radiation has emerged as a method to preserve the native bladder in highly motivated patients. A number of factors can impact the likelihood of long term bladder preservation after trimodality therapy, and therefore should be taken into account when selecting patients. New radiation techniques such as intensity modulated radiation therapy and image guided radiation therapy may decrease the toxicity of radiotherapy in this setting, but remain an area of active study. Novel chemotherapy regimens may improve response rates and minimize toxicity.

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“…James et al berichten in ihrem selektionierten Patientenklientel nur über eine geringe Lymphknotenrezidivrate (6.7 %) nach alleiniger Bestrahlung der Blase [45,66]. Allerdings ist bekannt, dass in anderen Kollektiven bis zu 26 % aller Patienten mit MIBC zum Zeitpunkt der RC bereits Lymphknotenmetastasen tragen [67]. Daher sollte bis zum Vorliegen weiterer prospektiver Studien weiterhin eine Bestrahlung der pelvinen Lymphabflusswege erwogen werden, trotz der erhöhten Toxizität.…”

Section: Tmt -Radiochemotherapieunclassified

Nur die Chirurgie? Multimodalkonzepte mit kurativer Intention für das Urothelkarzinom der Harnblase

2020

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ZusammenfassungDie radikale Zystektomie ist der Goldstandard zur Behandlung des muskelinvasiven Urothelkarzinoms. Insbesondere bei Patienten mit fortgeschrittenen Tumoren spielen multimodale, neoadjuvante oder adjuvante Therapiekonzepte eine zunehmend wichtige Rolle für die optimale Patientenversorgung. Zudem sind bei älteren und komorbideren Patienten, die unfit für eine radikale Zystektomie sind, alternative Therapiekonzepte erforderlich. Dieser Artikel fasst die aktuelle Literatur multimodaler Therapien im neoadjuvanten und adjuvanten Setting zusammen und beleuchtet Alternativen zur radikalen Zystektomie mit kurativem Therapieansatz. Ebenfalls werden erste Erkenntnisse über den Einsatz neuer, vielversprechender Therapieoptionen wie der Immuncheckpoint-Blockade im multimodalen Therapieansatz zusammengefasst.

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Occult Pelvic Lymph Node Involvement in Bladder Cancer: Implications for Definitive Radiation

Cited by 34 publications

References 17 publications

Neutrophil‐to‐lymphocyte ratio as a bladder cancer biomarker: Assessing prognostic and predictive value in SWOG 8710

Neutrophil‐to‐lymphocyte ratio as a bladder cancer biomarker: Assessing prognostic and predictive value in SWOG 8710

Trimodality Therapy in Bladder Cancer

Nur die Chirurgie? Multimodalkonzepte mit kurativer Intention für das Urothelkarzinom der Harnblase

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