In the AJCC 7th edition, bladder cancer with lymph node metastasis is classified into stage IV regardless of the extent or number of lymph node metastasis. T1A-T4a, N1, and M0 were changed to stage IIIA, and T1a-T4a, N2-N3, and M0 were changed to stage IIIB in the AJCC 8th edition revised in 2018. Therefore, it is necessary to think about treatment strategy for clinically node positive bladder cancer. The aim of this study was to compare the treatment outcomes of chemotherapy, surgery, and combination therapy in patients with lymph node-positive bladder cancer.
From January 01, 2010 to December 31, 2015, patients with bladder cancer with clinically local lymph node metastasis at the time of diagnosis and were treated with neoadjuvant chemotherapy followed by cystectomy or cystectomy followed by adjuvant chemotherapy or palliative chemotherapy or cystectomy were retrospectively analyzed based on the clinical indices and survival time based on the medical record review.
Of 230 patients with bladder cancer, 44(19.1%) were treated with palliative chemotherapy, 30(13.0%) with neoadjuvant chemotherapy followed by cystectomy, 129(56.1%) with cystectomy followed by adjuvant chemotherapy, and 27(11.7%) with cystectomy alone. Median survival was 30.4 months retrospectively. In palliative chemotherapy group, median OS was 19.3 months. Median OS for neoadjuvant chemotherapy followed by cystectomy was 49.1 months and for cystectomy followed by adjuvant chemotherapy was 42.6 months. Cystectomy show 11.2 months of median OS. The prognosis was different according to stage of lymph node in each groups (42.6 months for N1 vs 21.3 months for N2-3), especially survival rate of cystectomy followed by adjuvant chemotherapy was good in N1 stage.
This study is meaningful in understanding the actual clinical treatment patterns of lymph node - positive bladder cancer and comparing the results according to each treatment group.
Clinical trial identification
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Has not received any funding.
All authors have declared no conflicts of interest.