STOCKHOLM, SWEDEN (UroToday.com) - Neoadjuvant chemotherapy (NAC) offers a survival benefit to patients with muscle-invasive bladder cancer (MIBC). A pathological complete response is seen in 40% and 10-15% of patients following NAC versus surgery alone, respectively. By contrast, data on the influence of NAC on lymph node involvement and data on the incidence of occult LN metastases after NAC are scarce. Dr. L. S. Mertens and colleagues investigated the influence of NAC on the incidence of LN metastases in clinically node-negative (cN0) patients with MIBC.
Included in the analysis were 441 patients with cN0M0 MIBC undergoing radical cystectomy (RC) between 1990 and 2012. Eighty-three patients received NAC, and the lymph node templates performed remained the same in both groups during the study period. In patients with cT3-T4 disease, the occurrence of LN metastases was significantly lower in patients treated with NAC (21.9% vs. 40.7%). Following multivariable adjustment for clinical stage, gender, and staging method, receipt of NAC was independently associated with a decreased likelihood of LN metastases (OR 0.41). No significant difference in overall and disease-specific survival was observed between patients treated with or without NAC. However, among those with clinical stage T3-T4 disease, median overall survival was significantly longer in the NAC group (68.0 versus 23.0 months).
NAC appears to be associated with reduced occurrence of occult LN metastases at the time of radical cystectomy. Given the retrospective nature of this study, a prospective study is needed to evaluate whether the effect of NAC on occult LN metastases improves survival.
Presented by L. S. Mertens at the 29th Annual European Association of Urology (EAU) Congress - April 11 - 15, 2014 - Stockholmsmässan - Stockholm, Sweden.
The Netherlands Cancer Institute, Department of Urology, Amsterdam, Netherlands
Written by Jeffrey J. Tomaszewski, MD, medical writer for UroToday.com