1595 EXTENDED LYMPHADENECTOMY AND CHEMOTHERAPY OFFER SURVIVAL ADVANTAGE IN MUSCLE-INVASIVE BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive1 Apr 20111595 EXTENDED LYMPHADENECTOMY AND CHEMOTHERAPY OFFER SURVIVAL ADVANTAGE IN MUSCLE-INVASIVE BLADDER CANCER Peter J. Bostrom, Tuomas Mirtti, Martti Nurmi, Matti Laato, Bas W.G van Rhijn, Neil E. Fleshner, Antonio Finelli, Michael A Jewett, and Alexandre R. Zlotta Peter J. BostromPeter J. Bostrom Toronto, Canada More articles by this author , Tuomas MirttiTuomas Mirtti Helsinki, Finland More articles by this author , Martti NurmiMartti Nurmi Turku, Finland More articles by this author , Matti LaatoMatti Laato Turku, Finland More articles by this author , Bas W.G van RhijnBas W.G van Rhijn Toronto, Canada More articles by this author , Neil E. FleshnerNeil E. Fleshner Toronto, Canada More articles by this author , Antonio FinelliAntonio Finelli Toronto, Canada More articles by this author , Michael A JewettMichael A Jewett Toronto, Canada More articles by this author , and Alexandre R. ZlottaAlexandre R. Zlotta Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1645AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The role of extended pelvic lymph node dissection (ePLND) and adjuvant chemotherapy in the treatment of muscle-invasive bladder cancer (BC) remain unclear. Our large database from two centers (Turku, Finland and Toronto, Canada) offer an opportunity to study these factors, as there have been different institutional practice policies. In Turku, ePLND was not common practice and adjuvant chemotherapy was nearly never offered whereas standard of care in Toronto included ePLND and adjuvant chemotherapy when indicated. METHODS Consecutive BC patients undergoing radical cystectomy in UHN, Toronto, Canada (1992–2008) and University of Turku, Turku, Finland (1986–2005) were studied. After exclusion of non-urothelial cases and neoadjuvant treatment, 563 patients were available for analysis. Clinicopathological variables, the rate and extent of PLND and the rate of adjuvant cisplatin-based chemotherapy were analyzed using the Chi-squared-test. Kaplan-Meier method and multivariate Cox regression analysis were used to analyze survival. RESULTS In the Toronto cohort, patients were older (mean age 68 vs. 63y, p<0.001), had more extensive PLNDs (>10 nodes removed, 58% vs. 8%, p<0.001), had more nodal metastasis (26% vs. 7%, p<0.001), and adjuvant chemotherapy was administered more often (21% vs. 1%, p<0.001). Positive margin rate was similar (4% in both centers). No BC specific survival differences could be demonstrated in ≤ pT2a tumors or in pT4a/b tumors. In contrast, there was a trend for improved survival in pT2b tumors (10y BC specific survival 65% vs. 42%, p=0.23) and a significant difference favouring the Toronto cohort in pT3a and pT3b tumors (55% vs. 31%, p=0.025; 43% vs. 28% p=0.06, respectively). In multivariate analysis, pT-stage (HR 1.8, 95% CI 1.2–2.8; p<0.005), N-stage (HR 2.5, 95% CI 1.5–4.1; p<0001), and ePLND (HR 0.53, 95% CI 0.31–0.93, p=0.026) significantly affected disease specific survival. Adjuvant chemotherapy offered borderline significant benefit (HR 0.61, 95% CI 0.36–1.05, p=0.072). An interaction model combining ePLND and chemotherapy was significant when ePLND with more than 10 nodes removed and adjuvant chemotherapy were combined (HR 0.49, 95% CI 0.26–0.92, p=0.026). CONCLUSIONS With the limitations of not being a randomized study but with an unique setting as our study centers had opposite management in terms of ePLND and adjuvant chemotherapy, our results show that the combination of ePLND and adjuvant chemotherapy offer a survival advantage in muscle-invasive BCs treated with RC. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e640 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter J. Bostrom Toronto, Canada More articles by this author Tuomas Mirtti Helsinki, Finland More articles by this author Martti Nurmi Turku, Finland More articles by this author Matti Laato Turku, Finland More articles by this author Bas W.G van Rhijn Toronto, Canada More articles by this author Neil E. Fleshner Toronto, Canada More articles by this author Antonio Finelli Toronto, Canada More articles by this author Michael A Jewett Toronto, Canada More articles by this author Alexandre R. Zlotta Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...