Comparative effectiveness of different treatment strategies for bladder cancer of regional lymph nodes involvement

Abstract

Objective Patients with bladder cancer with clinical lymph node involvement (cN+ ) are at high risk for distant metastases, but are potentially curable. Such patients are excluded fromneoadjuvant chemotherapy trials and pooled with patients with distant metastases in first-line chemotherapy trials not suited to define the role of combined-modality therapy. To analyze a comparative effectiveness for avoiding invalid evidence. Methods A retrospective study was conducted for 522 patients who underwent chemotherapy and/or cystectomy between January 2003 and January 2013 for cTanyN1-3M0 bladder cancer patients. We used multivariable adjustment for tumor- and patient- characteristics to assess effectiveness. Results Among 522 patients (cN1, 47%; cN2, 43%; cN3, 10%), 342 patients underwent cystectomy and 180 patients were treated with chemotherapy alone. Of the cystectomy patients, 116 patients received preoperative and 96 patients received adjuvant chemotherapy. The crude 5-year OS for chemotherapy alone, cystectomy alone, preoperative chemotherapy followed by cystectomy, and cystectomy followed by adjuvant chemotherapy was 12%(95% CI: 9%~14%), 19%(95% CI: 13%~23%), 32%(95% CI: 26%~37%), 25%(95% CI: 20%~32%), respectively. Compared with cystectomy alone, preoperative chemotherapy was associated with a significant improvement in OS (HR 0.68, 95% CI: 0.54~0.92). Adjuvant chemotherapy was also associated with a significant improvement in survival compared with cystectomy alone. The survival in patients were treated with chemotherapy alone was worse than those were treated with cystectomy alone. Conclusions The patients with cN+ bladder cancer achieves long survival.Combined-modality therapy, with chemotherapy and cystectomy, is associated with the best effect. Key words: Urinary Bladder Neoplasms; Lymph Nodes; Cystectomy