Abstract
PurposeTo examine the relationship between the number of tumour draining sentinel nodes (SNs) and pathoanatomical outcomes, in muscle-invasive bladder cancer (MIBC), in patients undergoing neoadjuvant chemotherapy (NAC) and radical cystectomy (RC).Materials and MethodsIn an ongoing prospective multicenter study, we included 230 patients with suspected urothelial MIBC from ten Swedish urological centers. All underwent TURb and clinical staging. From the cohort, 116 patients with urothelial MIBC; cT2-cT4aN0M0, underwent radical cystectomy (RC) and lymphadenectomy with SN-detection (SNd). 83 patients received cisplatin-based NAC and 33 were NAC-naïve. The number and locations of detected SNs and non-SNs were recorded for each patient. The NAC treated patients were categorized by pathoanatomical outcomes post-RC into three groups: complete responders (CR), stable disease (SD) and progressive disease (PD). Selected covariates with possible impact on SN-yield were tested in uni -and multivariate analyses for NAC-treated patients only.ResultsIn NAC treated patients, the mean number of SNs was significantly higher in CR patients (3.3) and SD patients (3.6) compared with PD patients (1.4) (p = 0.034). In a linear multivariate regression model, the number of harvested nodes was the only independent variable that affected the number of SNs (p = 0.0004).ConclusionsThe number of tumor-draining SNs in NAC-treated patients was significantly lower in patients with progressive disease.
Highlights
Urinary bladder cancer (UBC) is the fourth most common malignancy in men and the eighth most common in women, in the Western world [1]
neoadjuvant chemotherapy (NAC) is associated with significant overall survival (OS) benefits; a large meta-analysis assigned it to an 8% absolute increase in 5-year OS [7]
Good survival benefits have been seen in patients where NAC induces complete downstaging (CD) of the primary tumour, suggesting CD to be a surrogate marker for efficacy on dissemination [8]
Summary
Urinary bladder cancer (UBC) is the fourth most common malignancy in men and the eighth most common in women, in the Western world [1]. Good survival benefits have been seen in patients where NAC induces complete downstaging (CD) of the primary tumour, suggesting CD to be a surrogate marker for efficacy on dissemination [8]. Evidence from recent years of SN-research in MIBC shows that the number of detectable SNs often exceed one single node [10,11,12]. Recent SN-research shows that NAC promotes antitumor T-cell responses in MIBC, by activating T-effector cells (Teffs) and reducing the immunosuppressive activity of regulatory T-cells (Tregs) in SNs. Higher Teff to activated Treg ratio has been established in patients where NAC has induced CD [21]. Considering the SN-role in the immune defence against cancer, we speculate that the greater the number of SNs in a patient, the higher the chance of non-progression due to NAC.
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