Lymph Node Status as a Predictor of Clinical Outcomes in Patients with Muscle-Invasive Bladder Cancer - Expert Commentary

Node-positive bladder cancer is a transitional step in the metastatic cascade between localized and metastatic disease. Wagner et al. examined the radiographical and pathological lymph node status as an independent predictor for survival following neoadjuvant gemcitabine and cisplatin in patients with muscle-invasive bladder cancer (MIBC) patients.

The cohort consisted of 96 patients. Overall, the 2-year cancer-specific survival rate was 79%. At five years, it was 64.9%. After a median of twelve months, 31 patients died, and the median follow-up duration among surviving patients was 40 months. At baseline, 44.8% of patients were positive for pelvic lymph node involvement (cN+), and 84.4% had a locally advanced tumor (cT3/4). After treatment with chemotherapy and radical cystectomy, 30.2% of patients exhibited a complete response (ypT0 ypN0) to chemotherapy, and 50% had a partial response (< ypT2 ypN0).

The median number of excised lymph nodes was 24. The complete and partial response rates of patients with positive lymph nodes were 23.3% and 39.5%, respectively. In addition, after the final histological analysis, 17% of patients who did not have radiographical lymph node involvement had postsurgical lymph node metastases (ypN+). Among these patients, 74% died after a median duration of nine months, and their 2-year cancer-specific survival was 35.4%. In a univariate analysis, cancer-specific survival was significantly correlated with cN status, ypN status, ypT status, resection margins, and response. A multivariate regression model revealed clinical and pathological lymph node statuses as significant prognostic variables for cancer-specific survival.

The findings from this study highlight the role of lymph node status in the risk stratification of patients with MIBC. Future studies with other markers of micro-metastasis, such as circulating tumor DNA, will enable more risk-stratified and adaptive neoadjuvant therapy in the future.

Written by: Bishoy M. Faltas MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine

References:

  1. Wagner J, Simon R, Büchler JW, et al. Both radiographical and pathological lymph node statuses are independent predictors for survival following neoadjuvant chemotherapy and radical cystectomy for cT3/4 or cN+ bladder cancer [published online ahead of print, 2022 Oct 21]. World J Urol. 2022;10.1007/s00345-022-04187-w. doi:10.1007/s00345-022-04187-w
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