Survival Outcomes of Patients with Pathologically Proven Positive Lymph Nodes at Time of Radical Cystectomy with or without Neoadjuvant Chemotherapy.

To compare overall survival (OS) outcomes in pN1-3 disease at the time of radical cystectomy (RC) for muscle invasive bladder according to the neoadjuvant chemotherapy (NAC) status.

This multicenter study included 450 consecutive patients undergoing RC for muscle-invasive urothelial bladder cancer with pN1-3 pM0 disease from 2010 to 2019. NAC consisted in platinum-based chemotherapy. The primary endpoint was the comparison between NAC and non-NAC in terms of death from any cause. OS was assessed using the Kaplan-Meier method and multivariate Cox proportional hazards regression was used to estimate adjusted hazard ratios.

Median age was 69 years. Patients receiving NAC were younger (p = 0.051), and more likely had downstaging to non-muscle invasive disease (10.7% versus 4.3%, p = 0.042). Median OS was 26.6 months. NAC patients had poorer OS compared with those who did receive NAC (Hazard ratio (HR) 1.6; p = 0.019). The persistence of muscle-invasive bladder in RC specimens was also significantly associated with OS (HR 2.40). In the NAC cohort, the two factors independently correlated with OS were the number of positive lymph nodes (p = 0.013) and adjuvant chemotherapy (AC) (HR 0.31; p = 0.015).

Persistent nodal disease in RC specimens after NAC was associated with poor prognosis and lower OS rates compared with pN1-3 disease after upfront RC. In this sub-group of NAC patients, AC was independently associated with better OS.

Journal of clinical medicine. 2020 Jun 23*** epublish ***

Guillaume Ploussard, Benjamin Pradere, Jean-Baptiste Beauval, Christine Chevreau, Christophe Almeras, Etienne Suc, Jean-Romain Gautier, Anne-Pascale Laurenty, Mathieu Roumiguié, Guillaume Loison, Christophe Tollon, Loïc Mourey, Ambroise Salin, Evanguelos Xylinas, Damien Pouessel

Department of Urology, La Croix du Sud Hospital, 31130 Quint Fonsegrives, France., Department of Urology, Bretonneau Hospital, 37000 Tours, France., Department of Oncology, IUCT-O, 31000 Toulouse, France., Department of Oncology, La Croix du Sud Hospital, 31130 Quint Fonsegrives, France., Department of Urology, CHU-IUC, 31000 Toulouse, France., Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique-Hopitaux de Paris, Paris University, 75018 Paris, France.