Fewer tumour draining sentinel nodes in patients with progressing muscle invasive bladder cancer, after neoadjuvant chemotherapy and radical cystectomy.

To examine the relationship between the number of tumour draining sentinel nodes (SNs) and pathoanatomical outcomes, in muscle-invasive bladder cancer (MIBC), in patients undergoing neoadjuvant chemotherapy (NAC) and radical cystectomy (RC).

In an ongoing prospective multicenter study, we included 230 patients with suspected urothelial MIBC from ten Swedish urological centers. All underwent TURb and clinical staging. From the cohort, 116 patients with urothelial MIBC; cT2-cT4aN0M0, underwent radical cystectomy (RC) and lymphadenectomy with SN-detection (SNd). 83 patients received cisplatin-based NAC and 33 were NAC-naïve. The number and locations of detected SNs and non-SNs were recorded for each patient. The NAC treated patients were categorized by pathoanatomical outcomes post-RC into three groups: complete responders (CR), stable disease (SD) and progressive disease (PD). Selected covariates with possible impact on SN-yield were tested in uni -and multivariate analyses for NAC-treated patients only.

In NAC treated patients, the mean number of SNs was significantly higher in CR patients (3.3) and SD patients (3.6) compared with PD patients (1.4) (p = 0.034). In a linear multivariate regression model, the number of harvested nodes was the only independent variable that affected the number of SNs (p = 0.0004).

The number of tumor-draining SNs in NAC-treated patients was significantly lower in patients with progressive disease.

World journal of urology. 2019 Nov 23 [Epub ahead of print]

Julia Alvaeus, Robert Rosenblatt, Markus Johansson, Farhood Alamdari, Tomasz Jakubczyk, Benny Holmström, Tammer Hemdan, Ylva Huge, Firas Aljabery, Susanne Gabrielsson, Katrine Riklund, Ola Winqvist, Amir Sherif

Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 901 85, Umeå, Sweden., Department of Urology, Västmanland Hospital, Västerås, Sweden., Department of Urology, Länssjukhuset Ryhov, Jönköping, Sweden., Department of Surgical Sciences, Uppsala University, Uppsala, Sweden., Division of Urology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden., Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden., Department of Radiation Sciences, Umeå University, Umeå, Sweden., Department of Clinical Immunology, Karolinska University Hospital, Stockholm, Sweden., Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 901 85, Umeå, Sweden. .