Oncological outcomes of patients with node positive disease following neoadjuvant chemotherapy and radical cystectomy for muscle-invasive bladder cancer: A multicenter observational study of the EAU Young Academic Urologists (YAU) urothelial carcinoma working group
Por:
Marcq, G, Kassouf, W, Roumiguié, M, Pradere, B, Mertens, LS, Albisinni, S, Cimadamore, A, Teoh, JYC, Moschini, M, Laukhtina, E, Mari, A, Soria, F, Gallioli, A, del Giudice, F, d'Andrea, D, Krajewski, W, Beauval, JB, Xylinas, E, Pouessel, D, Sargos, P, Ploussard, G
Publicada:
1 mar 2025
Ahead of Print:
1 mar 2025
Resumen:
Introduction: Until recently there was no recommended adjuvant therapy for patients with lymph nodes metastasis (ypN+) following neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). The aim of the study was to describe the oncological outcomes of ypN+ patients following NAC and RC for MIBC. Methods: This collaborative retrospective study included 195 patients with ypN+ disease after NAC followed by RC and bilateral pelvic lymph node dissection for MIBC between 2000 and 2019 in seven centers. Patients' demographics, clinical and pathological features were collected. Survival analyses were carried out with Kaplan-Meier estimates and a Cox model was generated. Results: A total of 120 patients (62%) were pN1, 51 pN2 (26%) and 24 pN3 (12%). Adjuvant radiation therapy was performed in 18 (9%), adjuvant chemotherapy in 40 (21%) and the remaining 137 (70%) patients were observed. The median follow-up time was 51 months (95% CI: 44-62). Median times for recurrence-free survival, cancer-specific survival and overall survival (OS) were 18 months (95% CI: 16-21), 47 months (95% CI: 31-70) and 28 months (95% CI: 22-34) respectively. On multivariable analysis, female gender (HR: 1.5, 95%CI: 1.002-2.21, P = .049) and positive surgical margins (HR: 1.6, 95%CI: 1.06-2.38, P = .026) were the only independent predictor of OS. The type of adjuvant therapy did not impact OS (adjuvant chemotherapy, P = .44; adjuvant radiotherapy, P = .40). Conclusion. - MIBC patients with residual node positive disease following NAC and RC have poor survival outcomes. Females and patients with positive margin status at RC carry a poorer prognosis. These results may be beneficial for clinical trial design.
Filiaciones:
Marcq, G:
McGill Univ, Ctr Salud, McGill Urol Oncol Res, Montreal, PQ, Canada
CHU Lille, Hosp Claude Huriez, Dept Urol, F-59000 Lille, France
Univ Lille, CANTHER Heterogeneidad Plasticidad & Resistencia C, CNRS, Inst Pasteur Lille,CHU Lille,Inserm,UMR9020,U1277, Lille, France
Kassouf, W:
McGill Univ, Ctr Salud, McGill Urol Oncol Res, Montreal, PQ, Canada
Roumiguié, M:
CHU Toulouse, Dept Urol, IUC, Toulouse, France
Pradere, B:
Hosp La Croix Sud, Dept Urol, Quint Fonsegrives, France
CeMM Res Ctr Mol Med, Viena, Austria
Mertens, LS:
Inst Urol, Dept Urol, Dhule, Maharashtra, India
Albisinni, S:
Univ Libre Bruselas, Inst Estudios Europeos, Bruselas, Belgium
Univ Roma Tor Vergata, Hosp Univ Tor Vergata, Dept Biomed & Prevent, Rome, Italy
Cimadamore, A:
Univ Politecn Marche, Secc Anat Patol, Ancona, Italy
Teoh, JYC:
Chinese Univ Hong Kong, Dept Surg, SH Ho Urol Ctr, Hong Kong, Peoples R China
Moschini, M:
IRCCS Inst Cient San Raffaele, Inst Invest Urol, Dept Urol, Milan, Italy
IRCCS Inst Cient San Raffaele, Inst Invest Urol, Div Oncol Expt, Milan, Italy
Laukhtina, E:
CeMM Res Ctr Mol Med, Viena, Austria
Sechenov Univ, Inst Urol & Salud Reprod, Moscu, Russia
Mari, A:
Univ Florence, Dept Oncol Minimally Invas Urol & Androl, Dept Med Expt & Clin, Unidad Urol Oncol & Androl Minimamente Invas, Florencia, Italy
Soria, F:
Azienda Osped Citta Salute & Sci Torino Molinette, Div Urol, AOU Ciudad Salud & Ciencia, Turin, Italy
Gallioli, A:
Univ Autonoma Barcelona, Fdn Puigvert, Dept Urol, Barcelona, Spain
del Giudice, F:
Univ Roma La Sapienza, Hosp Policlin Umberto I, Dept Ciencias Maternoinfantiles & Urol, Rome, Italy
d'Andrea, D:
CeMM Res Ctr Mol Med, Viena, Austria
Krajewski, W:
Univ Med Breslavia, Ctr Univ Excelencia Urol, Dept Urol Robot & Minimamente Invas, Breslavia, Poland
Beauval, JB:
Hosp La Croix Sud, Dept Urol, Quint Fonsegrives, France
Xylinas, E:
Paris Diderot Univ, Univ Hosp Paris, AP HP, Dept Urol, Paris, France
Pouessel, D:
Inst Claudius Regaud, IUCT Inst Univ Canc Toulouse Oncopole, Dept Oncol Med, Toulouse, France
Sargos, P:
Inst Bergonie, Burdeos, France
Ploussard, G:
Hosp La Croix Sud, Dept Urol, Quint Fonsegrives, France
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