Outcomes of radical cystectomy with extended lymphadenectomy alone in patients with lymph node-positive bladder cancer who are unfit for or who decline adjuvant chemotherapy.

Details

Serval ID
serval:BIB_000B9DA4C5C8
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Outcomes of radical cystectomy with extended lymphadenectomy alone in patients with lymph node-positive bladder cancer who are unfit for or who decline adjuvant chemotherapy.
Journal
BJU international
Author(s)
Zehnder P., Studer U.E., Daneshmand S., Birkhäuser F.D., Skinner E.C., Roth B., Miranda G., Burkhard F.C., Cai J., Skinner D.G., Thalmann G.N., Gill I.S.
ISSN
1464-410X (Electronic)
ISSN-L
1464-4096
Publication state
Published
Issued date
04/2014
Peer-reviewed
Oui
Volume
113
Number
4
Pages
554-560
Language
english
Notes
Publication types: Evaluation Study ; Journal Article ; Multicenter Study
Publication Status: ppublish
Abstract
To analyse the long-term outcomes of patients with lymph node (LN)-positive bladder cancer, who did not receive any adjuvant therapy after radical cystectomy (RC) and extended pelvic lymph node dissection (ePLND).
We conducted a retrospective, combined cohort analysis based on two prospectively maintained cystectomy databases from the University of Southern California and the University of Bern. Eligible patients underwent RC with ePLND for cN0M0 disease but were found to have LN-positive disease. No patient had neoadjuvant therapy, and all had negative surgical margins. Kaplan-Meier plots were used to estimate recurrence-free survival (RFS) and overall survival (OS). Subgroup comparisons were performed using log-rank tests, and multivariable analysis was based on Cox proportional hazard models.
Of 521 patients with LN-positive disease, 251 (48%) never received adjuvant therapy. Although the pathological stage distribution was similar, the 251 patients who did not receive adjuvant therapy were older and had both fewer total and positive LNs than those who underwent adjuvant therapy. The median RFS for patients treated with RC alone was 1.6 years. Recurrences mainly occurred <2 years after RC, resulting in 5- and 10-year RFS rates of 32 and 26%, respectively. Pathological T stage, the total number of LNs and the number of positive LNs detected were independent predictors of RFS and OS.
In this study, 25% of patients with documented LN metastases who did not receive adjuvant therapy were cured with RC and ePLND; however, a few relapses may occur later than 3 years. Predictors of survival were pathological T stage, the number of total LNs and the number of positive LNs identified.
Keywords
Adult, Aged, Aged, 80 and over, Chemotherapy, Adjuvant, Cystectomy/methods, Disease-Free Survival, Female, Humans, Lymph Node Excision/methods, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Staging, Prospective Studies, Retrospective Studies, Treatment Outcome, Treatment Refusal, Urinary Bladder Neoplasms/pathology, Urinary Bladder Neoplasms/therapy, cystectomy, extended lymphadenectomy, no chemotherapy, outcome
Pubmed
Web of science
Open Access
Yes
Create date
08/01/2021 15:36
Last modification date
09/01/2021 6:26
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