Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Apr 27;2(2):263-272.
doi: 10.3233/BLC-150032.

Benefit of Adjuvant Chemotherapy and Pelvic Lymph Node Dissection in pT3 and Node Positive Bladder Cancer Patients Treated with Radical Cystectomy

Peter J Boström  1 , Tuomas Mirtti  2 , Bas van Rhijn  3 , Neil E Fleshner  3 , Antonio Finelli  3 , Matti Laato  4 , Michael A Jewett  3 , Malcom J Moore  5 , Srikala Sridhar  5 , Martti Nurmi  4 , Ian F Tannock  5 , Alexandre R Zlotta  3
Affiliations
Free PMC article

Benefit of Adjuvant Chemotherapy and Pelvic Lymph Node Dissection in pT3 and Node Positive Bladder Cancer Patients Treated with Radical Cystectomy

Peter J Boström et al. Bladder Cancer. .
Free PMC article

Abstract

Background: Benefits of adjuvant chemotherapy (AC) and extent of pelvic lymph node dissection (PLND) in radical cystectomy (RC) are debated. Results from randomized trials are still expected. Objective: To analyze the effects of AC and PLND in two academic centers with opposite policies regarding their use. Methods: 581 bladder cancer patients who underwent RC without neoadjuvant chemotherapy, from Toronto (University Health Network), Canada, and Turku University Hospital, Finland were included. Disease specific survival (DSS) and failure patterns were assessed. Results: Centers differed in PLND rate (93% and 36% in Toronto and Turku respectively, p < 0.001), PLND extent (≥10 removed nodes, 58% vs. 8%, p < 0.001) and AC rate (21% vs. 2%, p < 0.001). Survival between centers among pT≤1 or pT4 patients was similar. pT3 patients in Toronto had an improved 10 year DSS (43% vs. 22%, p = 0.025). Distant failures were less common after AC (HR 0.56, 95% CI 0.33-0.98, p < 0.042). In node positive (N+) patients, mortality was significantly higher in Turku (HR 2.19, 95% CI 1.44-3.34, p < 0.001) and lower in patients receiving AC (HR 0.60, 95% CI 0.37-0.99, p = 0.044). 41% DSS at 10 years was observed in N+ Toronto patients. Limitations included the non-randomized retrospective design and absence of propensity score analysis. Conclusion: Combining AC and PLND to RC is associated with improved survival in pT3 and N+ patients. PLND did not affect survival independently but helps in selecting patients for AC. Our data adds to the growing body of evidence supporting the usefulness of AC in addition to PLND in high risk patients operated by cystectomy.

Keywords: Bladder cancer; adjuvant chemotherapy; lymphadenectomy; radical cystectomy.

PubMed Disclaimer

Figures

Fig.1
Fig.1
Kaplan-Meier analysis for disease specific survival for the University of Toronto (A) and the University of Turku (B).
Fig.2
Fig.2
Kaplan-Meier analysis comparing disease specific survival between the University of Toronto and the University of Turku cohorts among pT2 patients (A) and pT3 patients (B).
Fig.3
Fig.3
Kaplan-Meier analysis for disease specific survival for University of Toronto (A) and University of Turku (B) for different nodal status.
Fig.4
Fig.4
Kaplan-Meier analysis for local recurrence free survival (A) and distance free recurrence survival (B) for University of Toronto and University of Turku.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Stein J, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, Skinner E, Bochner B, Thangathurai D, Mikhail M, Raghavan D, Skinner DG. Radical cystectomy in the treatment of invasive bladder cancer: Long-term results in 1,054 patients. J Clin Oncol 2001;19:666–75. - PubMed
    1. Madersbacher S, Hochreiter W, Burkhard F, Thalmann GN, Danuser H, Markwalder R, Studer UE. Radical cystectomy for bladder cancer today–a homogeneous series without neoadjuvant therapy. J Clin Oncol 2003;21:690–6. - PubMed
    1. Hautmann R, Gschwend J, de Petriconi R, Kron M, Volkmer BG. Cystectomy for transitional cell carcinoma of the bladder: Results of a surgery only series in the neobladder era. J Urol 2006;176:486–92. - PubMed
    1. Shariat S, Karakiewicz P, Palapattu G, Lotan Y, Rogers CG, Amiel GE, Vazina A, Gupta A, Bastian PJ, Sagalowsky AI, Schoenberg MP, Lerner SP. Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: A contemporary series from the Bladder Cancer Research Consortium. J Urol 2006;176:2414–22. - PubMed
    1. Sternberg CN, Skoneczna I, Kerst JM, Albers P, Fossa SD, Agerbaek M, Dumez H, de Santis M, Théodore C, Leahy MG, Chester JD, Verbaeys A, Daugaard G, Wood L, Witjes JA, de Wit R, Geoffrois L, Sengelov L, Thalmann G, Charpentier D, Rolland F, Mignot L, Sundar S, Symonds P, Graham J, Joly F, Marreaud S, Collette L, Sylvester R. Immediate versus deferred chemotherapy after radical cystectomy in patients with pT3-pT4 or N+ M0 urothelial carcinoma of the bladder (EORTC 30994): An intergroup, open-label, randomised phase 3 trial. Lancet Oncol 2015;16(1), 76–86. - PubMed