Natural history of pT3-4 or node positive bladder cancer treated with radical cystectomy and no neoadjuvant chemotherapy in a contemporary North-American multi-institutional cohort

Abstract

Background: The present study documents the natural history and outcomes of high-risk bladder cancer after radical cystectomy (RC) in patients who did not receive neoadjuvant chemotherapy during a contemporary time period. Methods: We analyzed 1180 patients from 1993 to 2008 with >pT3N0 or pT0-4N+ bladder cancer who underwent RC ± standard (sLND) or extended (eLND) lymph node dissection from 8 Canadian centres. Results: Of the 1180 patients, 55% (n = 643) underwent sLND, 34% (n = 402) underwent ePLND and 11% did not undergo a formal LND. Of the total number of patients, 321 (27%) received adjuvant chemotherapy. The median follow-up was 2.1 years (range: 0.6 to 12.9). Overall 30-day mortality was 3.2%. Clinical and pathological stages T3-4 were present in 6.1% and 86.7% of the patients, respectively; this demonstrates a dramatic understaging. Overall survival (OS) at 2 and 5 years was 60% and 43%, respectively. Patients who received adjuvant chemotherapy had a 2-and 5-year disease-specific survival (DSS) of 72% and 57% versus 64% and 51% for those who did not (log-rank p = 0.0039). The 2-and 5-year OS for high-risk node-negative disease was 67% and 52%, respectively, whereas for node-positive patients, the OS was 52% and 32%, respectively (p < 0.001). The OS, DSS and RFS for patients with pN0 were significantly improved compared to those who did not undergo a LND (log-rank p = 0.0035, 0.0241 and 0.0383, respectively). Interpretation: This series suggests that bladder cancer outcomes in advanced disease have improved in the modern era. The need for improved staging investigations, use of neoadjuvant chemotherapy and performance of complete LND is emphasized.

Clinical interval and diagnostic characteristics in a cohort of bladder cancer patients in Spain: a multicenter observational study

“…Our multicenter study in Spain included 314 patients mostly diagnosed with bladder urothelial cell carcinoma. The population characteristics were similar to those described in previously published studies [ 2 , 17 – 21 ]. The majority of bladder cancers started with symptoms, being hematuria the most frequent.…”

Adjuvant cisplatin‐based combined chemotherapy for lymph node (LN)‐positive urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC): a retrospective international study of >1500 patients

“…Molecular biomarkers may further help to identify patients for AC, but this approach is still experimental . In our present study, patients with pT3–4 UCB, high LN density, and LVI benefited most from AC, which is in accordance with other studies . Further, younger patients and women appeared to benefit more from AC, which may in part be explained by selection bias.…”

Plasmacytoid Urothelial Carcinoma: Response to Chemotherapy and Oncologic Outcomes

“…In the literature, historical data for conventional UC reported lower rates of cT3/4 stage (11%) at diagnosis and pT3/4 (43%) stage at RC [14]. Positive surgical margins have a reported incidence of 1-10% in conventional UC across stages [15], and up to 12% in cases of extravesical disease extension [16]. Nodal-positive disease at RC can be found in approximately 25% in general, and up to 34% in patients with advanced pT stage [16,17].…”