Surgical intervention in patients with urothelial carcinoma of the bladder and lymph node metastasis

Abstract

Purpose of reviewTo systematically review the most recent evidence on the role of surgery in patients with urothelial carcinoma of bladder and lymph node metastasis. Recent findingsPatients with urothelial carcinoma of bladder and lymph node metastasis have a poor prognosis. The mainstay treatment for these patients is systemic chemotherapy. However, slowly growing body of literature suggests that multimodal therapy comprised of radical cystectomy, lymph node dissection, and perioperative chemotherapy is more effective than either chemotherapy or surgery alone. The timing of chemotherapy, whether preoperative or adjuvant chemotherapy, is still controversial, but the current evidence indicates that patients who achieve a major or complete response after induction chemotherapy appear to benefit from the surgical intervention in the form of radical cystectomy and pelvic lymph node dissection. The limit of lymph node dissection has to be determined. SummaryMultimodal therapy is associated with better survival outcomes in bladder cancer patients with lymph node metastasis. The current guidelines recommend systemic chemotherapy as the mainstay of treatment for these patients, and there is no convincing evidence on the efficacy of surgical intervention in isolation. Nonetheless, studies comparing multiple treatment modalities demonstrated that surgical salvage therapy is beneficial only when combined with chemotherapy. The methodological limitations of the current literature preclude a robust conclusion of survival advantage. Further studies are needed to help improve imaging for detecting lymph node metastasis and novel strategies to enrich our multimodal therapeutic implementation.

Bladder cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up

“…Patients with clinical node positivity benefit from preoperative platinum-based ChT followed by RC plus PLND. [38][39][40] Overall, the number of positive LNs is significantly associated with increased risk of cancer-specific death (HR 1.9, 95% CI 1.04-3.46 for N1 disease; HR 4.3, 95% CI 2.25-8.34 for ≥2 LNs). 41…”

Uncovering the potential functions of lymph node metastasis-associated aberrant methylation differentially expressed genes and their association with the immune infiltration and prognosis in bladder urothelial carcinoma

“…The presence or absence of lymph node metastasis has a very important influence on the treatment strategy and survival prognosis of patients ( Lu et al, 2019 ). The prognosis of BLCA patients with lymph node metastasis is poor ( Abufaraj et al, 2021 ). Epigenetic modifications, especially DNA methylation, play an important role in the regulation of cancer progression ( Makabe et al, 2019 ; Schulz & Goering, 2016 ).…”