Clinically node-positive (cN+) urothelial carcinoma of the bladder treated with chemotherapy and radical cystectomy: Clinical outcomes and development of a postoperative risk stratification model.

Although node-positive (cN+) bladder cancer is considered Stage IV disease, a subset of patients is treated with chemotherapy and consolidative radical cystectomy (RC). We examined the clinical outcomes of such patients and developed a risk prediction model to facilitate risk-stratification and management.

We identified adult patients with cTany cN1-3 M0 urothelial carcinoma of the bladder treated with chemotherapy followed by RC from 2006 to 2013 in the NCDB. The associations of clinicopathologic features with overall survival (OS) were evaluated using Cox regression, and a simplified risk score was developed.

A total of 491 patients received chemotherapy followed by RC. Median number of lymph nodes removed was 16 (interquartile range 9-25). At RC, 10% of patients were ypT0, and 35% were ypN0. Over a median follow-up of 18.7 months, 160 patients died of any cause. 1-, 5-, and 8-year OS were 69%, 34%, and 29%, respectively. On multivariable analysis, pT stage (hazard ratio [HR] 2.18; P = 0.003 for pT3, HR 2.65; P < 0.001 for pT4 vs. <pT2) and pN stage (HR 1.77; P = 0.02 for pN1; HR 2.58; P < 0.001 for pN2; HR 5.09; P < 0.001 for pN3 vs. pN0) were independently associated with worse OS. A risk score was developed based on pT and pN stages, with 5-year OS of 59%, 24%, and 10% for risk score groups of 0-1, 2, and ≥3 points.

Survival for patients with cN+ bladder cancer treated with chemotherapy and RC is highly variable, ranging from 10% to 59% at 5 years. A risk score can facilitate postoperative risk-stratification and selection of patients for adjuvant therapy.

Urologic oncology. 2019 Oct 05 [Epub ahead of print]

Osama Al-Alao, Catrina Mueller-Leonhard, Simon P Kim, Ali Amin, Christopher Tucci, Ohad Kott, Anthony Mega, Dragan Golijanin, Boris Gershman

Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI; Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI., Lifespan Oncology Clinical Research, The Miriam Hospital, Providence, RI., University of Colorado Anschutz Medical Center, Division of Urology, Aurora, CO., Warren Alpert Medical School of Brown University, Providence, RI; Department of Pathology and Laboratory Medicine, The Miriam Hospital, Providence, RI., Warren Alpert Medical School of Brown University, Providence, RI; Department of Hematology/Oncology, The Miriam Hospital, Providence, RI., Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI; Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI; Warren Alpert Medical School of Brown University, Providence, RI., Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: .