Survival and metastasis in muscle-invasive bladder cancer patients who present with indeterminate pulmonary nodules before treatment.

Abstract

BACKGROUNDIndeterminate pulmonary nodules (IPNs) are common during initial evaluation of bladder cancer patients. Their significance is still unknown.OBJECTIVEDetermine the significance of indeterminate pulmonary nodules, including their size and number, in muscle-invasive bladder cancer patients before definitive local therapy by surgery or chemo-radiotherapy.DESIGNRetrospective review, single-center descriptive study.SETTINGSA tertiary cancer center.PATIENTS AND METHODSWe performed a retrospective review of patients who underwent definitive local therapy of bladder cancer by either radical cystectomy and lymph node dissection or with chemo-radiotherapy between January 1997 and December 2015. We identified patients with baseline CT scans done during staging work-up prior to definitive treatment. Patients with proven clinical metastasis at presentation were excluded, while patients who had IPNs without features suggesting metastasis were included.MAIN OUTCOME MEASURESDisease-free survival and overall survival.SAMPLE SIZE168 patients.RESULTSThe median age of patients at diagnosis was 66 years; 92% were males and 56% were smokers. IPNs (3 cm or less) were present in 74 patients (44.0%). Median follow-up was 24 months. IPNs were associated with decreased disease-free survival while IPNs did not affect the overall survival (HR=1.9; 95% CI: 1.1–3.4); P=.01 and HR=1.5; 95% CI: 1.0–2.5); P=.07, respectively. In addition, nodules >1 cm had reduced disease-free survival (HR=2.5; 95% CI: 1.1–5.9); P=.04. In the surgery group (n=126), the median number of lymph nodes excised was 14, with no association between lymph nodes status and the presence of IPNs (P=.08).CONCLUSIONThe presence of IPNs, especially nodules >1 cm had a negative effect on disease-free survival. Tailored postoperative follow-up of these patients may impact disease outcomes.LIMITATIONSThe retrospective nature, the lack of standardized preoperative imaging protocols, the lack of a central radiology review and the small number of patients.