Comparative Assessment of Chemotherapy Followed by Consolidative Radical Cystectomy Versus Chemoradiation for Clinically Node-Positive Urothelial Carcinoma of the Bladder
Por:
Slusarczyk, A, Scilipoti, P, Contieri, R, Longoni, M, de Angelis, M, Miszczyk, M, Krajewski, W, Laukthina, E, Del Giudice, F, Gallioli, A, Rajwa, P, Pradere, B, Shah, PR, Boorjian, SA, Moschini, M, Radziszewski, P
Publicada:
1 oct 2025
Ahead of Print:
1 jul 2025
Resumen:
This study compares outcomes between chemoradiation (CRT) and radical cystectomy (RC) with neoadjuvant chemotherapy in 552 patients with clinically node-positive (cN + ) invasive bladder cancer. Using SEER data and IPTW-adjusted survival analyses, we found that RC was associated with significantly lower cancer-specific and all-cause mortality (ACM) compared to CRT (5-yr ACM 70% vs. 85%). Findings highlight the need for optimized systemic therapies, as long-term survival remains poor in this population. Context: Patients with bladder cancer and clinically positive pelvic lymph nodes (cN+) have poor prognosis, and the optimal definitive treatment method remains controversial. Objective: To compare survival outcomes between chemotherapy followed by radical cystectomy (RC) and chemoradiation (CRT) in patients with cN+ bladder cancer. Methods: We queried the Surveillance, Epidemiology, and End Results (2000-2021) database to identify patients with cN+ bladder cancer treated with CRT or chemotherapy and RC. Cumulative incidence functions, Fine-Gray model, and Cox proportional hazards were used for the survival analysis. Inverse probability treatment weighting (IPTW) was used to adjust for confounders. The primary endpoints were cancer-specific mortality (CSM) and all-cause mortality (ACM). Results: Among 552 patients identified, 175 (32%) received CRT and 377 (68%) underwent chemotherapy plus RC, and 5-year ACM was 75% (95% confidence interval [CI]: 71%-78%). RC and CRT were associated with 5-year CSM of 62% (95% CI: 57%-67%) and 72% (95% CI: 65%-78%), and 5-year ACM of 70% (95% CI: 65%-75%) and 85% (95% CI: 75%-90%), respectively. After IPTW, on multivariable Cox proportional hazard analysis adjusted for nodal and tumor staging, age, gender, tumor size and race, RC was associated with a significantly lower risk of CSM (hazard ratio [HR]: 0.47, 95% CI: 0.37-0.60, P < .001) and ACM (HR: 0.53, 95% CI: 0.46-0.60, P < .001). Conclusions: Patients with cN+ bladder cancer who received CRT had a worse prognosis compared to those who underwent chemotherapy followed by RC. The incorporation of more effective systemic therapies is required to improve outcomes, as in our analysis, only one in four cN+ patients survived beyond 5 years. (c) 2025 The Author(s).Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
Filiaciones:
Slusarczyk, A:
Med Univ Warsaw, Dept Gen Oncol & Funct Urol, Lindleya 4, PL-02005 Warsaw, Poland
Scilipoti, P:
IRCCS Osped San Raffaele, Urol Res Inst, Div Expt Oncol, Unit Urol, Milan, Italy
Contieri, R:
Ist Nazl Tumori Napoli IRCCS Fdn G Pascale, Dept Urol, Naples, Italy
Longoni, M:
IRCCS Osped San Raffaele, Urol Res Inst, Div Expt Oncol, Unit Urol, Milan, Italy
de Angelis, M:
IRCCS Osped San Raffaele, Urol Res Inst, Div Expt Oncol, Unit Urol, Milan, Italy
Miszczyk, M:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
WSB Univ, Fac Med, Coll Med, Dabrowa Gornicza, Poland
Krajewski, W:
Wroclaw Med Univ, Dept Urol & Oncol Urol, Wroclaw, Poland
Laukthina, E:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Del Giudice, F:
Sapienza Univ, Umberto I Policlin Hosp, Dept Maternal Infant & Urol Sci, Rome, Italy
Gallioli, A:
Autonomous Univ Barcelona, Dept Urol, Puigvert Fdn, Barcelona, Spain
Rajwa, P:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
UCL, Div Surg & Intervent Sci, London, England
Univ Coll London Hosp, London, England
Ctr Postgrad Med Educ, Dept Urol 2, Warsaw, Poland
Pradere, B:
La Croix Du Sud Hosp, Dept Urol UROSUD, Quint Fonsegrives, France
Shah, PR:
Mayo Clin, Dept Urol, Rochester, MN USA
Boorjian, SA:
Mayo Clin, Dept Urol, Rochester, MN USA
Moschini, M:
IRCCS Osped San Raffaele, Urol Res Inst, Div Expt Oncol, Unit Urol, Milan, Italy
Radziszewski, P:
Med Univ Warsaw, Dept Gen Oncol & Funct Urol, Lindleya 4, PL-02005 Warsaw, Poland
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