The cohort consisted of 96 patients. Overall, the 2-year cancer-specific survival rate was 79%. At five years, it was 64.9%. After a median of twelve months, 31 patients died, and the median follow-up duration among surviving patients was 40 months. At baseline, 44.8% of patients were positive for pelvic lymph node involvement (cN+), and 84.4% had a locally advanced tumor (cT3/4). After treatment with chemotherapy and radical cystectomy, 30.2% of patients exhibited a complete response (ypT0 ypN0) to chemotherapy, and 50% had a partial response (< ypT2 ypN0).
The median number of excised lymph nodes was 24. The complete and partial response rates of patients with positive lymph nodes were 23.3% and 39.5%, respectively. In addition, after the final histological analysis, 17% of patients who did not have radiographical lymph node involvement had postsurgical lymph node metastases (ypN+). Among these patients, 74% died after a median duration of nine months, and their 2-year cancer-specific survival was 35.4%. In a univariate analysis, cancer-specific survival was significantly correlated with cN status, ypN status, ypT status, resection margins, and response. A multivariate regression model revealed clinical and pathological lymph node statuses as significant prognostic variables for cancer-specific survival.
The findings from this study highlight the role of lymph node status in the risk stratification of patients with MIBC. Future studies with other markers of micro-metastasis, such as circulating tumor DNA, will enable more risk-stratified and adaptive neoadjuvant therapy in the future.
Written by: Bishoy M. Faltas MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine
References:
- Wagner J, Simon R, Büchler JW, et al. Both radiographical and pathological lymph node statuses are independent predictors for survival following neoadjuvant chemotherapy and radical cystectomy for cT3/4 or cN+ bladder cancer [published online ahead of print, 2022 Oct 21]. World J Urol. 2022;10.1007/s00345-022-04187-w. doi:10.1007/s00345-022-04187-w