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The impact of treatment modality on survival in patients with clinical node-positive bladder cancer: results from a multicenter collaboration
L. Afferi, S. Zamboni, RJ. Karnes, F. Roghmann, P. Sargos, F. Montorsi, A. Briganti, A. Gallina, A. Mattei, GB. Schulz, K. Hendricksen, CS. Voskuilen, M. Rink, C. Poyet, O. De Cobelli, E. di Trapani, C. Simeone, M. Soligo, G. Simone, G. Tuderti,...
Language English Country Germany
Document type Journal Article, Multicenter Study
- MeSH
- Chemotherapy, Adjuvant MeSH
- Cystectomy MeSH
- Induction Chemotherapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Lymph Node Excision MeSH
- Lymphatic Metastasis MeSH
- Survival Rate MeSH
- Urinary Bladder Neoplasms mortality pathology therapy MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
PURPOSE: To assess the impact of perioperative chemotherapy on survival in cN+ BCa patients and analyze it according to the pN status. METHODS: A retrospective analysis was conducted on 639 BCa patients with cTanyN1-3M0 BCa treated with radical cystectomy (RC) and bilateral lymph node dissection (LND) with or without perioperative chemotherapy in ten tertiary referral centers from 1990 to 2017. Selected cN+ patients received induction chemotherapy (IC), whereas adjuvant chemotherapy (ACT) was delivered to selected pN+ patients. Univariable and multivariable Cox regression analyses were used to predict overall mortality (OM) after surgery, adjusting for clinicopathological confounders. Kaplan-Meier analyses assessed OM according to the treatment modality. RESULTS: Overall, 356 (56%) patients were treated with surgery alone, 155 (24%) with IC followed by surgery, and 128 (20%) with ACT following surgery. Over a median follow-up of 25 months, 316 deaths were recorded. At univariable analysis, patients treated with IC and surgery had lower OM both considering cN+ [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.49-0.87, p = 0.004] and cN+pN- patients (HR 0.61, 95% CI 0.37-0.99, p = 0.05) compared to those treated with surgery alone. cN+pN+ patients treated with ACT experienced lower OM compared to those treated with IC or surgery alone at multivariable analysis (HR 0.40, 95% CI 0.22-0.74, p = 0.003). CONCLUSION: Patients with cTany cN+ cM0 BCa benefit more in terms of OS when treated with IC followed by RC + LND compared to RC + LND alone, regardless of LNMs at final histopathology examination. More data are needed to assess the role of ACT in the management of cN+ patients.
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Urology Bichat Hospital Paris Descartes University Paris France
Department of Urology IRCCS Regina Elena National Cancer Institute Rome Italy
Department of Urology La Paz University Hospital Madrid Spain
Department of Urology Luzerner Kantonsspital Lucerne Switzerland
Department of Urology Marien Hospital Ruhr University Bochum Herne Germany
Department of Urology München Klinik Bogenhausen Munich Germany
Department of Urology Spedali Civili Hospital University of Brescia Brescia Italy
Department of Urology University Hospital Zürich University of Zürich Zürich Switzerland
Department of Urology University Medical Center Hamburg Eppendorf Hamburg Germany
Department of Urology University of Texas Southwestern Medical Center Dallas TX USA
Department of Urology Weill Cornell Medical College New York Presbyterian Hospital New York NY USA
Division of Urology European Institute of Oncology Milan Italy
Instituto de Investigación Hospital Universitario La Paz Madrid Spain
Mayo Clinic Urology Rochester MN USA
The National Center for Diabetes Endocrinology and Genetics The University of Jordan Amman Jordan
References provided by Crossref.org
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- $a The impact of treatment modality on survival in patients with clinical node-positive bladder cancer: results from a multicenter collaboration / $c L. Afferi, S. Zamboni, RJ. Karnes, F. Roghmann, P. Sargos, F. Montorsi, A. Briganti, A. Gallina, A. Mattei, GB. Schulz, K. Hendricksen, CS. Voskuilen, M. Rink, C. Poyet, O. De Cobelli, E. di Trapani, C. Simeone, M. Soligo, G. Simone, G. Tuderti, M. Alvarez-Maestro, L. Martínez-Piñeiro, A. Aziz, SF. Shariat, M. Abufaraj, E. Xylinas, M. Moschini, European Association of Urology-Young Academic Urologists (EAU-YAU), Urothelial Carcinoma Working Group
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- $a PURPOSE: To assess the impact of perioperative chemotherapy on survival in cN+ BCa patients and analyze it according to the pN status. METHODS: A retrospective analysis was conducted on 639 BCa patients with cTanyN1-3M0 BCa treated with radical cystectomy (RC) and bilateral lymph node dissection (LND) with or without perioperative chemotherapy in ten tertiary referral centers from 1990 to 2017. Selected cN+ patients received induction chemotherapy (IC), whereas adjuvant chemotherapy (ACT) was delivered to selected pN+ patients. Univariable and multivariable Cox regression analyses were used to predict overall mortality (OM) after surgery, adjusting for clinicopathological confounders. Kaplan-Meier analyses assessed OM according to the treatment modality. RESULTS: Overall, 356 (56%) patients were treated with surgery alone, 155 (24%) with IC followed by surgery, and 128 (20%) with ACT following surgery. Over a median follow-up of 25 months, 316 deaths were recorded. At univariable analysis, patients treated with IC and surgery had lower OM both considering cN+ [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.49-0.87, p = 0.004] and cN+pN- patients (HR 0.61, 95% CI 0.37-0.99, p = 0.05) compared to those treated with surgery alone. cN+pN+ patients treated with ACT experienced lower OM compared to those treated with IC or surgery alone at multivariable analysis (HR 0.40, 95% CI 0.22-0.74, p = 0.003). CONCLUSION: Patients with cTany cN+ cM0 BCa benefit more in terms of OS when treated with IC followed by RC + LND compared to RC + LND alone, regardless of LNMs at final histopathology examination. More data are needed to assess the role of ACT in the management of cN+ patients.
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