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:

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.

Cancer medicine. 2019 Jul 29 [Epub ahead of print]

Woo Kyun Bae, Hyo Jin Lee, Se Hoon Park, Jung Hoon Kim, Hee Jun Kim, Chi Hoon Maeng, Inkeun Park, Byeong Seok Sohn, Jung A Kim, Kyung Hee Lee, Do Hyoung Lim, Hyun Chang, Sung Min Kim, Ho Young Kim, Hunho Song, Seungtaek Lim, Jae Ho Byun, Hyun Ae Jung

Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea., Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea., Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea., Department of Hemato-Oncology, Gyeongsang National University hospital, Jinju, Republic of Korea., Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea., Division of Medical Oncology-Hematology, Department of Medicine, College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea., Division of Medical Oncology, Department of Internal medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea., Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea., Division of Medical Oncology-Hematology, Department of Medicine, College of Medicine, Kangdong Kyung Hee University Hospital, Seoul, Republic of Korea., Department of Hemato-Oncology, College of Medicine, Yeungnam University, Daegu, Republic of Korea., Department of Hemato-Oncology, Dankook University Hospital, Cheonan, Republic of Korea., Department of Medical Oncology, Catholic Kwandong University International St. Mary's Hospital, Incheon, Republic of Korea., Division of Hematology-Oncology, Department of Medicine, Samsung Changwon, Sungkyunkwan University School of Medicine, Changwon, Korea., Department of Internal Medicine, College of Medicine, Hallym University Medical Center, Hallym University, Anyang, Korea., Department of Internal Medicine, College of Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, South Korea., Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju, Korea., Division of Oncology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea.