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. 2022 Jan;40(1):111-118.
doi: 10.1007/s00345-021-03839-7. Epub 2021 Sep 28.

Occult lymph node metastases in patients without residual muscle-invasive bladder cancer at radical cystectomy with or without neoadjuvant chemotherapy: a nationwide study of 5417 patients

L M C van Hoogstraten  1   2 , E J van Gennep #  3 , L A L M Kiemeney  4   5 , J A Witjes  4 , C S Voskuilen  6 , M Deelen  7 , L S Mertens  6 , R P Meijer  8 , J L Boormans  9 , D G J Robbrecht  10 , L V Beerepoot  11 , R H A Verhoeven  12   13 , T M Ripping  12 ; BlaZIB Study Group; B W G van Rhijn  14 , K K H Aben #  12   5 , T J N Hermans #  15
Affiliations

Occult lymph node metastases in patients without residual muscle-invasive bladder cancer at radical cystectomy with or without neoadjuvant chemotherapy: a nationwide study of 5417 patients

L M C van Hoogstraten et al. World J Urol. 2022 Jan.

Abstract

Purpose: Little is known about the prevalence of occult lymph node metastases (LNM) in muscle-invasive bladder cancer (MIBC) patients with pathological downstaging of the primary tumor. We aimed to estimate the prevalence of occult LNM in patients without residual MIBC at radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC) or neoadjuvant radiotherapy (NAR), and to assess overall survival (OS).

Methods: Patients with cT2-T4aN0M0 urothelial MIBC who underwent RC plus pelvic lymph node dissection (PLND) with curative intent between January 1995-December 2013 (retrospective Netherlands Cancer Registry (NCR) cohort) and November 2017-October 2019 (prospective NCR-BlaZIB cohort (acronym in Dutch: BlaaskankerZorg In Beeld; in English: Insight into bladder cancer care)) were identified from the nationwide NCR. The prevalence of occult LNM was calculated and OS of patients with <(y)pT2N0 vs. <(y)pT2N+ disease was estimated by the Kaplan-Meier method.

Results: In total, 4657 patients from the NCR cohort and 760 patients from the NCR-BlaZIB cohort were included. Of 1374 patients downstaged to <(y)pT2, 4.3% (N = 59) had occult LNM 4.1% (N = 49) of patients with cT2-disease and 5.6% (N = 10) with cT3-4a-disease. This was 4.0% (N = 44) in patients without NAC or NAR, 4.5% (N = 10) in patients with NAC, and 13.5% (N = 5) in patients with NAR but number of patients treated with NAR and downstaged disease was small. The prevalence of <(y)pT2N+ disease was 4.2% (N = 48) in the NCR cohort and 4.6% (N = 11) in the NCR-BlaZIB cohort. For patients with <(y)pT2N+ and <(y)pT2N0, median OS was 3.5 years (95% CI 2.5-8.9) versus 12.9 years (95% CI 11.7-14.0), respectively.

Conclusion: Occult LNM were found in 4.3% of patients with cT2-4aN0M0 MIBC with (near-) complete downstaging of the primary tumor following RC plus PLND. This was regardless of NAC or clinical T-stage. Patients with occult LNM showed considerable worse survival. These results can help in counseling patients for bladder-sparing treatments.

Keywords: Bladder cancer; Downstaging; Lymph node metastases; Neoadjuvant chemotherapy; Radical cystectomy.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
a–b Overall survival of patients with and without occult lymph node metastases in cT2-4aN0M0 urothelial bladder cancer without evidence of residual bladder cancer [(y)pT0] at radical cystectomy (a) or residual muscle-invasive disease [(y)pT0/a/is/1] at radical cystectomy (b)
See this image and copyright information in PMC

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