Trends in Treatment Strategies and Comparison of Outcomes in Lymph Node Positive Bladder Cancer: An Analysis of the National Cancer Database

Darwish, Christina; Sparks, Andrew; Amdur, Richard; Reddy, Akshay; Whalen, Michael J.

doi:10.1016/j.urology.2020.06.091

Cited by 14 publications

(17 citation statements)

References 25 publications

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“…At present, there is limited information in the literature concerning neoadjuvant therapy for patients with LNM, but in a study involving 1,739 patients with BCA with LNM, preoperative neoadjuvant chemotherapy was associated with a greater improvement of OS than radical cystectomy alone (hazard ratio=0.80, 95% CI: 0.66-0.97) (3). A study by Darwish et al also reported that among cT2-4N1-3M0 patients who received neoadjuvant therapy, the disease category in 53 patients (12.7%) was down-staged to pT0N0, with a 72% lower risk of death and a 5-year OS of 85.4%, compared with those who remained at stage pT0N+ (9). Therefore, it is crucial to determine the lymph node status of patients with BCA before formulating the treatment strategy because although patients with LNM have a high risk of distant metastasis, they can be cured if a comprehensive multimodal treatment is actively chosen.…”

Section: Discussionmentioning

confidence: 95%

“…A study by Darwish et al. also reported that among cT2-4N1-3M0 patients who received neoadjuvant therapy, the disease category in 53 patients (12.7%) was down-staged to pT0N0, with a 72% lower risk of death and a 5-year OS of 85.4%, compared with those who remained at stage pT0N+ ( 9 ). Therefore, it is crucial to determine the lymph node status of patients with BCA before formulating the treatment strategy because although patients with LNM have a high risk of distant metastasis, they can be cured if a comprehensive multimodal treatment is actively chosen.…”

Section: Discussionmentioning

confidence: 97%

“…The treatment strategy for patients with BCA varies according to the lymph node status. BCA patients with LNM can still get cured before distant metastasis if appropriate treatment is chosen ( 9 ). Therefore, it is crucial to accurately estimate the lymph node status of patients with BCA.…”

Section: Introductionmentioning

confidence: 99%

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Predictive Nomogram and Risk Factors for Lymph Node Metastasis in Bladder Cancer

et al. 2021

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Lymph node metastasis (LNM) is an important prognostic factor for bladder cancer (BCA) and determines the treatment strategy. This study aimed to determine related clinicopathological factors of LNM and analyze the prognosis of BCA. A total of 10,653 eligible patients with BCA were randomly divided into training or verification sets using the 2004–2015 data of the Surveillance, Epidemiology, and End Results database. To identify prognostic factors for the overall survival of BCA, we utilized the Cox proportional hazard model. Independent risk factors for LNM were evaluated via logistic regression analysis. T-stage, tumor grade, patient age and tumor size were identified as independent risk factors for LNM and were used to develop the LNM nomogram. The Kaplan-Meier method and competitive risk analyses were applied to establish the influence of lymph node status on BCA prognosis. The accuracy of LNM nomogram was evaluated in the training and verification sets. The areas under the receiver operating characteristic curve (AUC) showed an effective predictive accuracy of the nomogram in both the training (AUC: 0.690) and verification (AUC: 0.704) sets. In addition, the calibration curve indicated good consistency between the prediction of deviation correction and the ideal reference line. The decision curve analysis showed that the nomogram had a high clinical application value. In conclusion, our nomogram displayed high accuracy and reliability in predicting LNM. This could assist the selection of the optimal treatment for patients.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 97%

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Predictive Nomogram and Risk Factors for Lymph Node Metastasis in Bladder Cancer

et al. 2021

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“…Currently, the standard treatment of patients with muscle-invasive bladder cancer is radical cystectomy (RC) with bilateral pelvic lymph node dissection (PLND) [99]. The available publications emphasize the oncological benefits of lymph node (LN) resection during cystectomy in comparison with its absence [77,79,[100][101][102].…”

Section: Treatment Of Cn+ Patientsmentioning

confidence: 99%

Management of Bladder Cancer Patients with Clinical Evidence of Lymph Node Invasion (cN+)

Małkiewicz¹,

Gurwin²,

Karwacki³

et al. 2022

Preprint

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The purpose of this review is to present the current knowledge about the diagnostic and treatment options in bladder cancer (BCa) patients with clinically positive lymph nodes (cN+). In this review compaction of CT and MRI performance in preoperative prediction of lymph node invasion (LNI) in BCa patients was presented, along with other diagnostic methods. Most scientific societies do not distinguish cN+ patients in their guidelines, recommendations concern muscle-invasive bladder cancer (MIBC) and differ between associations. Currently, the standard treatment of patients with MIBC is radical cystectomy (RC) with bilateral pelvic lymph node dis-section (PLND). The template of PLND and its therapeutic value remain debatable. Moreover, most guidelines recommend neoadjuvant chemotherapy (NAC). However, there is still lack of definitive evidence of the superiority of neoadjuvant chemotherapy over adjuvant chemotherapy. Nevertheless, the curative treatment that provides the best long-term survival in cN+ patients is a multimodal approach with a combination of chemotherapy and RC. Recent studies demonstrate the growing importance of immunotherapy. Special attention should be paid to cN+ BCa patients as the oncological outcomes are significantly worse for this group.

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“…metastasis confined to the lymph nodes) appear to benefit from systemic chemotherapy (CHT) in terms of overall survival (OS) [7,8 ▪ ]. The real benefit of surgical interventions, on the other hand, remains unclear due to several limitations, such as the historical exclusion of node-positive BCa in randomized control trials and the lack of high-level evidence on this subgroup of patients [6 ▪ ,7,9 ▪ ].…”

Section: Introductionmentioning

confidence: 99%

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

Abufaraj

Al-Ani

AlQudah

et al. 2021

Current Opinion in Urology

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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.

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Trends in Treatment Strategies and Comparison of Outcomes in Lymph Node Positive Bladder Cancer: An Analysis of the National Cancer Database

Cited by 14 publications

References 25 publications

Predictive Nomogram and Risk Factors for Lymph Node Metastasis in Bladder Cancer

Predictive Nomogram and Risk Factors for Lymph Node Metastasis in Bladder Cancer

Management of Bladder Cancer Patients with Clinical Evidence of Lymph Node Invasion (cN+)

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

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