To assess the impact of perioperative chemotherapy on survival in cN+ BCa patients and analyze it according to the pN status.
A retrospective analysis was conducted on 639 BCa patients with cTanyN1-3M0 BCa treated with radical cystectomy (RC) and bilateral lymph node dissection (LND) with or without perioperative chemotherapy in ten tertiary referral centers from 1990 to 2017. Selected cN+ patients received induction chemotherapy (IC), whereas adjuvant chemotherapy (ACT) was delivered to selected pN+ patients. Univariable and multivariable Cox regression analyses were used to predict overall mortality (OM) after surgery, adjusting for clinicopathological confounders. Kaplan-Meier analyses assessed OM according to the treatment modality.
Overall, 356 (56%) patients were treated with surgery alone, 155 (24%) with IC followed by surgery, and 128 (20%) with ACT following surgery. Over a median follow-up of 25 months, 316 deaths were recorded. At univariable analysis, patients treated with IC and surgery had lower OM both considering cN+ [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.49-0.87, p = 0.004] and cN+pN- patients (HR 0.61, 95% CI 0.37-0.99, p = 0.05) compared to those treated with surgery alone. cN+pN+ patients treated with ACT experienced lower OM compared to those treated with IC or surgery alone at multivariable analysis (HR 0.40, 95% CI 0.22-0.74, p = 0.003).
Patients with cTany cN+ cM0 BCa benefit more in terms of OS when treated with IC followed by RC + LND compared to RC + LND alone, regardless of LNMs at final histopathology examination. More data are needed to assess the role of ACT in the management of cN+ patients.
World journal of urology. 2020 Apr 30 [Epub ahead of print]
Luca Afferi, Stefania Zamboni, R Jeffrey Karnes, Florian Roghmann, Paul Sargos, Francesco Montorsi, Alberto Briganti, Andrea Gallina, Agostino Mattei, Gerald Bastian Schulz, Kees Hendricksen, Charlotte S Voskuilen, Michael Rink, Cedric Poyet, Ottavio De Cobelli, Ettore di Trapani, Claudio Simeone, Matteo Soligo, Giuseppe Simone, Gabriele Tuderti, Mario Alvarez-Maestro, Luis Martínez-Piñeiro, Atiqullah Aziz, Shahrokh F Shariat, Mohammad Abufaraj, Evanguelos Xylinas, Marco Moschini, European Association of Urology-Young Academic Urologists (EAU-YAU), Urothelial Carcinoma Working Group
Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland., Mayo Clinic Urology, Rochester, MN, USA., Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany., Department of Radiation Oncology, Jewish General Hospital, McGill University Health Centre, Montreal, Canada., Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy., Urologische Klinik Und Poliklinik, Klinikum Der Universität München, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany., Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland., Division of Urology, European Institute of Oncology, Milan, Italy., Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy., Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy., Department of Urology, La Paz University Hospital, Madrid, Spain., Department of Urology, München Klinik Bogenhausen, Munich, Germany., Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria., Department of Urology Bichat Hospital, Paris Descartes University, Paris, France., Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland. .