Abstract
METHODS
A retrospective, multicenter cohort study was performed, concerning patients identified within three large bladder cancer centres diagnosed with lymph-node-positive bladder cancer (cN1-3). The primary objective was to assess whether clinical response to initial systemic therapy was associated subsequent treatment decisions (either no further treatment or radical local therapy; radical cystectomy or (chemo)radiation) and was associated with overall survival. The prognostic impact of lymph-node status and type of local radical treatment was assessed.
CONCLUSIONS
In this retrospective cohort, clinical response to initial systemic therapy, rather than baseline nodal stage, was associated with allocation to radical local treatment and with improved survival. These findings support response-adapted decision-making in node-positive bladder cancer and warrant prospective validation.
RESULTS
In 259 patients with lymph-node-positive bladder cancer (median age 64.9; 71%male; 44.8% cN2-3), those with clinical response (complete or partial response) to initial systemic therapy (p < 0.001) more often proceeded to radical local treatment, whereas the cN-status was not associated with treatment decision. Whether radical cystectomy or (chemo)radiation was chosen as local treatment was not influenced by clinical response (p = 0.57). Compared with responders, non-responders had significantly worse overall survival (HR 1.77, 95% CI 1.09-2.88; p = 0.02). Initial cN-stage and type of radical treatment were not independently associated with survival.
PURPOSE
Patients with clinically node-positive bladder cancer represent a heterogeneous group with overall poor prognosis. Treatment recommendations within the guidelines remain ill-defined. This study evaluates whether clinical response to initial systemic therapy and baseline clinical nodal stage were associated with subsequent treatment decisions and survival outcomes.