Table 1 –
Studies reporting the outcomes of patients with clinically positive lymph node bladder cancer who underwent radical cystectomy and pelvic lymph node dissection
| Reports | Patients (n) | Study population | Chemotherapy |
Surgery | Pathologic response rate | Survival |
|||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Regimen (%) | Median no. of cycles | Clinical response rate | Median follow up (mo) | Rate (%) | Median survival time (mo) | Other findings | |||||
| Herr et al [15] 2001 | 80 | Unresectable or regionally metastatic BCa | MVAC: 75% Others: 25% |
4 | cCR: 30% cPR: 55% |
RC, PLND with or without RPLND | pCR: 62.5%a pCR: 15.9%b |
60 (minimum) | 5-yr OS: 42% | NR | Complete response to CHT and surgery: 41% |
| Nieuwenhuijzen et al.[12] 2005 | 52 | Histologically proven pN+ by aspiration (40%) or by PLND (60%) | MVAC: 59% HD-MVAC: 41% |
4 | cCR: 29% cPR: 57% |
RC with PLND: 19 (36.5%) Only RC 21 (40.4%) | pCR: 73%a
pCR: 14%b |
68 | Overall 5-yr CSS: 23% 5-yr CSS in cCR: 42% 5-yr CSS in cPR: 19% In nonrespondent: 0% |
15.4 | cCR (HR 8) and post CHT cT any, cN0 (HR 2.8) were independently associated with better CSS |
| Kassouf et al [16] 2009 | 37 | pT any, pN+ pts who received preoperative CHT. 18 (48.6%) pts were cN+. | Platinum-based: 30 81% Other treatments: 7 23.3% |
5 | NR | RC with PLND | All pN+ Only one pT0 | 50 | 2-yr OS: 20% 2-yr DSS: 29.2% 2-yr RFS: 13.5% |
OS: 13 DSS: 14.6 RFS: 6 |
Variant histology was associated with shorter OS (p = 0.01) and RFS (p = 0.036) Female sex was associated with OS (HR 0.25, p = 0.006) |
| Ghadjar et al [17] 2011 | 30 | T4cN0cM0: 20% ≥cT4cN+cM0: 70% ≥cT4cN0cM+: 10% | GC: 64% MVAC: 3% Others: 33% |
4 | In cN+ patients cCR: 76% cPR: 5% |
RC with PLND | pCR (pT0: 30%) pCR (pN0:50%) |
28 | 5-yr DFS: 42% 5-yr OS: 46% For patients with pT0: 5-yr DFS: 83% 5-yr OS: 71% |
NR | pT0 was significantly associated with both increased DFS (HR 0.08) and increased OS (HR 0.21) |
| Meijer et al[13] 2014 | 149 | cN+M0: 78% cNx, M1: 22% |
MVAC: 21% HD-MVAC: 40% GC: 13% Others: 26% |
4 | cCR: 34.9% cPR: 47.7% SD: 12.1% PD: 5.4% |
RC with PLND: 79% EBRT: 9% No local treatment: 12% |
pCR: 26.8% pPR: 28.2% pSD: 23.5% |
57 | Overall 5-yr CSS: 29.2% 5-yr CSS in pCR: 63.5% 5-yr CSS in cCR: 43.3% |
CSS for total group: 20 CSS in pCR: 127 CSS in cCR: 36 |
In patients with cCR, residual disease was present in 38.5% pPR (HR 2.31) and pSD (HR 4.02) were independently associated with CSS |
| Urakami et al [11] 2015 | 60 | cN+ BCa: 31 cN+ UTUC: 29 |
GC: 57% Others: 43% |
4 | cCR: 24% cPR: 57% SD: 20% PD 8% |
Consolidative surgery in 85% | pCR: 14% | 22.2 | 5-yr PFS: 39% OS: 42% |
NR | pN0 (HR 6.8), absence of lymphovascular invasion (HR 3.3), negative surgical margins (HR 5.1) and more LNs removed (HR 3.0) were independent postsurgical prognostic factors for OS in the surgical group |
| Ho et al [18] 2016 | 55 | cN+: 53% cM1: 47% |
Cisplatin-based: 92.7% Noncisplatin-based: 7.3% |
5 | cCR: 38.2% cPR: 45.5% SD: 9.1% PD: 1.8% |
RC, PLND, with or without RPLND | pT0:22% pN0: 55% |
58.7 | Overall 5-yr CSS: 40.4% 5-yr CSS rate for pN0: 66% 5-yr CSS rate for pN+: 12% 5-yr RFS: 39% |
CSS: 25.7 (all patients) CSS: 35.5 (cN+) CSS: 22.6 (cM1) |
No differences in response rates after CHT in cN1 and cN2 No difference between cN+ and cM1 in terms of OS Perioperative mortality: 1.8% |
| Zargar-Shoshtari et al [14] 2016 | 304 | cN+ | MVAC: 42% GC: 43% Others: 15% |
4 | NR | RC with PLND | pCR: 14.5% pPR: 27% CNR: 48% |
13 | 50% of patients died during follow up 44% died of BCa | OS: 23 OS for MVAC: 20 OS for GC: 24 OS for other regimens: 19 |
Positive surgical margins (HR 2.96), ≥2 positive LNs (HR 3.26) and number of nodes removed (HR 0.55) were independently associated with OS |
| Galsky et al[19] 2016 | 1104 | cTanyN1–3M0 | Preoperative CHT: 32% Adjuvant CHT: 30% |
NR | NR | RC alone: 37% CHT + RC: 32% RC + CHT: 30% |
cPR (pT0pN 0): 9% CNR (pN0: 37% |
16.6 | 5-yr OS in RC alone: 19% 5-yr OS CHT + RC: 31% 5-yr OS RC + CHT: 26% |
NR | Preoperative CHT (HR 0.8) and postoperative CHT (HR 0.68) were associated with a significant improvement in OS compared to RC alone |
BCa = bladder cancer; cCR = clinical complete response; CHT = chemotherapy; CI = confidence interval; CNR = complete nodal response; CSS = cancer-specific survival; DFS = disease free survival; EBRT = external beam radiotherapy; GC = gemcitabine and cisplatin; HD-MVAC = high-dose methotrexate, vinblastine, doxorubicin, and cisplatin; HR = hazard ratio; MVAC = methotrexate, vinblastine, doxorubicin, and cisplatin; NR = not reported; OS = overall survival; pCR = pathological complete response; PD = progressive disease; PFS = progression free survival; PLND = pelvic lymph node dissection; pPR = pathological partial response; pSD = pathological stable disease; RC = radical cystectomy; RFS = recurrence free survival; RPLND = retroperitoneal lymph node dissection; SD = stable disease; UTUC = upper tract urothelial carcinoma.
In patients clinically defined as complete responders.
In patients clinically defined as partial responders.