Fewer tumour draining sentinel nodes in patients with progressing muscle invasive bladder cancer, after neoadjuvant chemotherapy and radical cystectomy

Abstract

Purpose To examine the relationship between the number of tumour draining sentinel nodes (SNs) and pathoanatomical outcomes, in muscle-invasive bladder cancer (MIBC), in patients undergoing neoadjuvant chemotherapy (NAC) and radical cystectomy (RC). Materials and Methods In an ongoing prospective multicenter study, we included 230 patients with suspected urothelial MIBC from ten Swedish urological centers. All underwent TURb and clinical staging. From the cohort, 116 patients with urothelial MIBC; cT2-cT4aN0M0, underwent radical cystectomy (RC) and lymphadenectomy with SN-detection (SNd). 83 patients received cisplatin-based NAC and 33 were NAC-naïve. The number and locations of detected SNs and non-SNs were recorded for each patient. The NAC treated patients were categorized by pathoanatomical outcomes post-RC into three groups: complete responders (CR), stable disease (SD) and progressive disease (PD). Selected covariates with possible impact on SN-yield were tested in uni-and multivariate analyses for NAC-treated patients only. Results In NAC treated patients, the mean number of SNs was significantly higher in CR patients (3.3) and SD patients (3.6) compared with PD patients (1.4) (p = 0.034). In a linear multivariate regression model, the number of harvested nodes was the only independent variable that affected the number of SNs (p = 0.0004). Conclusions The number of tumor-draining SNs in NAC-treated patients was significantly lower in patients with progressive disease.

Sentinel Lymph Node Techniques in Urologic Oncology: Current Knowledge and Application

“…This finding is in accordance with similar studies in other malignancies [118,119]. More recent studies have assessed SLN techniques in various clinical settings and concluded that they are feasible and safe in BCa, although their efficacy remains questionable [120][121][122]. In 2022, Rietbergen et al initiated a prospective pilot study evaluating the usage of a hybrid ICG-99m Tc-nanocolloid radiotracer.…”

Occult lymph node metastases in patients without residual muscle-invasive bladder cancer at radical cystectomy with or without neoadjuvant chemotherapy: a nationwide study of 5417 patients

“…In a recent single center study, Zarifmahmoudi et al reported a SN detection rate of 85% and a false negative rate as high as 42% [ 26 ]. However, another MIBC study concluded that SN detection played no role in staging of nodal disease since the vast majority of LNM were detected in the non-sentinel lymph nodes [ 27 ]. The high number of false negatives would, therefore, lead to understaging if one does not proceed with PLND if the outcome of the SN is negative.…”

The increasing indications of FDG-PET/CT in the staging and management of Invasive Bladder Cancer

“…al's multicentre analysis which identified a higher average number of tumour-draining sentinel lymph nodes in patients treated with NAC who belonged to the Complete Response rather than the Progressive Disease cohort, thereby implying that the number of positive LNs is directly proportional to the strength of the immune system. 53 Conversely, whilst submission of separate nodal packets instead of en-block has shown a significant increase in total LN yield, this was not associated with an increased number of positive LNs, making LN density an inaccurate prognostic indicator. 54 Approximately 41% of metastatic lymph nodes are outside the confines of the standard PLND template, implying that an extended or super-extended PLND would yield superior oncological outcomes.…”