396 CANCER-SPECIFIC MORTALITY FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER WITH LYMPH NODE INVOLVEMENT: IMPACT OF DISEASE FEATURES AND ADJUVANT CHEMOTHERAPY

Abstract

You have accessJournal of UrologyUrothelial Cancer: Natural History, Markers & Pathophysiology1 Apr 2013396 CANCER-SPECIFIC MORTALITY FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER WITH LYMPH NODE INVOLVEMENT: IMPACT OF DISEASE FEATURES AND ADJUVANT CHEMOTHERAPY Marisa Clifton, Stephen Boorjian, John Cheville, Robert Tarrell, Prabin Thapa, R. Jeffrey Karnes, and Igor Frank Marisa CliftonMarisa Clifton Rochester, MN More articles by this author , Stephen BoorjianStephen Boorjian Rochester, MN More articles by this author , John ChevilleJohn Cheville Rochester, MN More articles by this author , Robert TarrellRobert Tarrell Rochester, MN More articles by this author , Prabin ThapaPrabin Thapa Rochester, MN More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes Rochester, MN More articles by this author , and Igor FrankIgor Frank Rochester, MN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1785AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While lymph node involvement (LNI) has been associated with adverse outcomes following radical cystectomy (RC), clinicopathologic variables associated with survival for these patients continue to be defined. In addition, conflicting data have been reported regarding the benefit of adjuvant chemotherapy for node positive (pN+) disease. We evaluate long-term survival among patients with LNI at RC including factors associated with death from bladder cancer in this setting. METHODS We reviewed our registry of 2462 patients who underwent RC between 1980-2006 to identify 323 (13.1 %) patients found to have LNI at surgery. All pathology specimens and lymph nodes (LN) were re-reviewed by a urologic pathologist (JCC). Survival was estimated using the Kaplan Meier method and compared with the log-rank test. Cox proportional hazard regression models were used to identify clinicopathologic variables associated with death from bladder cancer. RESULTS Median number of LN removed among patients with LNI was 12 (IQR 7, 19), while the median number of positive LN was 2 (IQR 1, 3). A total of 119 (37.3%) patients received adjuvant chemotherapy, including 67 (20.7%) who received cisplatin. Median follow-up was 8.5 (IQR 5.8, 15.6) years, during which time 270 patients died, including 199 from bladder cancer. 5-year cancer-specific survival (CSS) among pN+ patients who received adjuvant chemotherapy was 36.5% versus 27% among pN+ patients without adjuvant chemotherapy (p=0.008). On multivariable analysis (Table), pT3/4 stage (HR 2.12; p=0.03), increasing number of positive LN (HR 1.07; p=0.004), and extranodal extension (HR 1.53; p=0.008) were associated with a significantly increased risk of death from bladder cancer. Meanwhile, an increasing total number of LN dissected (HR 0.98; p=0.02) and receipt of adjuvant chemotherapy (HR 0.60; p=0.002) were associated with improved CSS. CONCLUSIONS Receipt of adjuvant chemotherapy as well as an increasing number of LN removed were associated with improved survival among patients with pN+ bladder cancer. These findings support the importance of a thorough lymphadenectomy with RC, and highlight the need for further assessment of the role for adjuvant chemotherapy, ideally in the clinical trial setting. Table. Multivariable analysis of clinicopathologic variables associated with death from bladder cancer among patients with lymph node involvement at RC Variable HR 95% CI p Value Age at surgery 1.00 0.98, 1.02 0.96 ECOG performance status 1.10 0.88, 1.38 0.41 pT2 (versus < or = pT1) 1.26 0.60, 2.62 0.55 pT3/4 (versus < or = pT1) 2.12 1.08, 4.16 0.03 Lymphovascular invasion 1.23 0.89, 1.68 0.21 Total number of lymph nodes removed 0.98 0.96, 0.99 0.02 Total number of positive nodes 1.07 1.02, 1.13 0.004 pN stage 1.29 0.92, 1.83 0.14 Extranodal extension 1.53 1.12, 2.10 0.008 Receipt of adjuvant chemotherapy 0.60 0.43, 0.83 0.002 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byChang S (2015) Re: 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 TrialJournal of Urology, VOL. 195, NO. 1, (63-64), Online publication date: 1-Jan-2016. Volume 189Issue 4SApril 2013Page: e160-e161 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marisa Clifton Rochester, MN More articles by this author Stephen Boorjian Rochester, MN More articles by this author John Cheville Rochester, MN More articles by this author Robert Tarrell Rochester, MN More articles by this author Prabin Thapa Rochester, MN More articles by this author R. Jeffrey Karnes Rochester, MN More articles by this author Igor Frank Rochester, MN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...