Cancer Res Treat.  2022 Jan;54(1):226-233. 10.4143/crt.2021.365.

The Prognosis and the Role of Adjuvant Chemotherapy for Node-Positive Bladder Cancer Treated with Neoadjuvant Chemotherapy Followed by Surgery

• Jeong H
• Park KJ
• Lee Y
• Kim HD
• Kim JH
• Yoon S
• Hong B
• Lee JL

• KMID: 2524603
• DOI: http://doi.org/10.4143/crt.2021.365

Abstract

Purpose
This study aims to evaluate the prognosis of pathologically node-positive bladder cancer after neoadjuvant chemotherapy, the role of adjuvant chemotherapy in these patients, and the value of preoperative clinical evaluation for lymph node metastases.
Materials and Methods
Patients who received neoadjuvant chemotherapy followed by partial/radical cystectomy and had pathologically confirmed lymph node metastases between January 2007 and December 2019 were identified and analyzed.
Results
A total of 53 patients were included in the study. The median age was 61 years (range, 34 to 81 years) with males comprising 86.8%. Among the 52 patients with post-neoadjuvant/pre-operative computed tomography results, only 33 patients (63.5%) were considered positive for lymph node metastasis. Sixteen patients (30.2%) received adjuvant chemotherapy (AC group), and 37 patients did not (no AC group). With the median follow-up duration of 67.7 months, the median recurrence-free survival (RFS) and the median overall survival (OS) was 8.5 months and 16.2 months, respectively. The 2-year RFS and OS rates were 23.3% and 34.6%, respectively. RFS and OS did not differ between the AC group and no AC group (median RFS, 8.8 months vs. 6.8 months, p=0.772; median OS, 16.1 months vs. 16.3 months, p=0.479). Thirty-eight patients (71.7%) experienced recurrence. Distant metastases were the dominant pattern of failure in both the AC group (91.7%) and no AC group (76.9%).
Conclusion
Patients with lymph node-positive disease after neoadjuvant chemotherapy followed by surgery showed high recurrence rates with limited survival outcomes. Little benefit was observed with the addition of adjuvant chemotherapy.

Keyword

Urinary bladder neoplasms; Neoadjuvant therapy; Chemotherapy; Adjuvant; Lymph node metastasis

Figure

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  Fig. 1 Kaplan-Meier plot: (A) recurrence-free survival and overall survival in the entire study population, (B) recurrence-free survival by adjuvant chemotherapy, (C) overall survival by adjuvant chemotherapy. Numbers shown in parentheses indicate a 95% confidence interval.

Reference

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