Induction Chemotherapy Followed by Surgery Versus Upfront Radical Cystectomy in Patients With Clinically Node-positive Muscle-invasive Bladder Cancer |
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| Affiliation: | 1. Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea;2. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea;1. Department of Urology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey;2. Department of Urology, Marmara University School of Medicine, Istanbul, Turkey;1. Department of Urology, University Hospital of Jena, Jena, Germany;2. EAU Research Foundation, Arnhem, The Netherlands;1. Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany;2. AUO Study Group, Germany;3. Department of Urology, University of Essen, Germany;4. Department of Urology, Heinrich Heine University, Düsseldorf, Germany;5. Department of Urology, Paracelsus Hospital Golzheim Düsseldorf, Düsseldorf, Germany;6. Department of Urology, Hospital of Karlsruhe, Germany;7. Department of Urology, Hospital of Kassel, Germany;8. Department of Urology, University of Cologne, Cologne, Germany;9. Department of Urology, Hospital of Fulda, Germany;10. Department of Urology, Saarland University Medical Center, Homburg, Germany;11. Department of Urology, Ulm University, Germany;12. Department of Urology, Eberhard Karls University, Tübingen, Germany;13. Department of Urology, Hospital Ludwigshafen, Germany;14. Department of Urology, Hospital Dortmund, Germany;15. Department of Urology, Helios Hospital, Wuppertal, Germany;p. Department of Urology, Otto von Guericke University, Magdeburg, Germany;q. Department of Urology, Hospital Holweide, Cologne, Germany;1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada;2. Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy;3. Vita-Salute San Raffaele University, Milan, Italy;4. Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;5. Department of Urology, European Institute of Oncology, Milan, Italy;6. Division of Medical Oncology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada;7. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany;8. Department of Urology, Medical University of Vienna, Vienna, Austria;9. Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada;10. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA |
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| Abstract: | BackgroundThe aim of this study was to compare survival outcomes in patients with clinically node-positive muscle-invasive bladder cancer receiving induction chemotherapy (IC) followed by surgery and those who underwent upfront radical cystectomy (RC).Patients and MethodsOutcomes were reviewed in patients with cT2-4N1-3M0 bladder cancer treated with IC followed by surgery or upfront RC between January 1995 and June 2017. Survival outcomes were analyzed using a propensity score matched cohort analysis.ResultsOf the 340 eligible patients, 106 received IC and 234 underwent upfront RC. The overall 3-year metastasis-free survival rate and 5-year cancer-specific survival rate of patients in the IC and RC groups were similar (49.4% vs. 46.0% and 49.6% vs. 49.8%, respectively). The 5-year cancer-specific survival rate of cN1-2 patients was higher in the IC group than the RC group (68.1% vs. 52.9%; P = .035). However, the 5-year cancer-specific survival rate of patients with cN3 cancers was significantly lower in the IC group than the RC group (19.2% vs. 44.5%; P = .015).ConclusionsIn this study, IC was seen to improve cancer-specific survival in patients with cN1-2 muscle-invasive bladder cancers but was associated with poorer survival outcomes than upfront RC in patients with cN3 cancers. Further investigation in prospective, randomized studies is warranted. |
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| Keywords: | Cystectomy Induction chemotherapy Lymph nodes Survival analysis Urinary bladder neoplasms |
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