scholarly journals The Influence of Lymph Node Count on Oncological Outcome of Radical Cystectomy in Chemotherapy Pre-Treated and Chemotherapy-Naïve Patients with Muscle Invasive Bladder Cancer

2021 ◽  
Vol 10 (21) ◽  
pp. 4923
Author(s):  
Artur Lemiński ◽  
Krystian Kaczmarek ◽  
Wojciech Michalski ◽  
Bartosz Małkiewicz ◽  
Katarzyna Kotfis ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Lymph Node ◽  
Radical Cystectomy ◽  
Oncological Outcome ◽  
Standard Of Care ◽  
Invasive Bladder Cancer ◽  
Study Cohort ◽  
Muscle Invasive Bladder Cancer ◽  
Lymph Node Count ◽  
Muscle Invasive

Radical cystectomy (RC) with pelvic lymph node dissection (PLND) remains the mainstay of treatment for muscle-invasive bladder cancer (MIBC). The extent of PLND and number of removed lymph nodes (LNs) have been associated with improved staging and survival outcomes in several series of RC patients. Neoadjuvant chemotherapy (NAC) has become standard of care for cisplatin-eligible patients qualified to RC, yet few studies on PLND stratified cases according to the receipt of NAC. We aimed to address this issue and reevaluate the prognostic value of PLND nodal yields in series of patients who underwent RC on the verge of the NAC era. This single-center, retrospective, clinical follow-up study enrolled 439 consecutive patients, out of whom 83 received NAC. We analyzed survival outcome of RC according to the number of removed nodes between NAC and non-NAC subgroups. We found PLND thresholds of 10 and 15 LNs prognostically meaningful in our study cohort, and this association was particularly pronounced in the non-NAC subgroup. Higher numbers of LNs provided a 25% reduction in risk of all-cause mortality and correspondingly correlated with up to a 14% increase in 3-year overall survival. The receipt of NAC diminished the benefit of adequate PLND, as the number of retrieved LNs was not associated with survival in the NAC-RC cohort. Given the limitations of our study, additional research is needed to verify these findings.

Effect of delayed radical cystectomy for invasive bladder tumors on lymph node positivity, cancer-specific survival and total survival

2018 ◽  
Vol 104 (6) ◽  
pp. 434-437
Author(s):  
Hakan Türk ◽  
Sıtkı Ün ◽  
Ahmet Cinkaya ◽  
Hilmi Kodaz ◽  
Murtaza Parvizi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Lymph Node ◽  
Radical Cystectomy ◽  
Transitional Cell ◽  
Invasive Bladder Cancer ◽  
Lymph Node Status ◽  
Muscle Invasive Bladder Cancer ◽  
Cancer Specific Survival ◽  
Muscle Invasive

Introduction: Radical cystectomy (RC) is the main treatment option for patients with muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC), which carry the highest risk of progression. In this study, we investigated the effect of time from transurethral resection of the bladder (TUR-B) to cystectomy on lymph node positivity, cancer-specific survival and overall survival in patients with MIBC. Methods: The records were reviewed of 530 consecutive patients who had RC and pelvic lymphadenectomy procedures with curative intent performed by selected surgeons between May 2005 and April 2016. Our analysis included only patients with transitional cell carcinoma of the bladder; we excluded 23 patients with other types of tumor histology. Results: Patients who underwent delayed RC were compared with patients who were treated with early RC; both groups were similar in terms of age, gender, T stage, tumor grade, tumor differentiation, lymph node status and metastasis status. However, when both groups were compared for disease-free survival and overall survival, patients of the early-RC group had a greater advantage. Conclusions: The optimal time between the last TUR-B and RC is still controversial. A reasonable time for preoperative preparation can be allowed, but long delays, especially those exceeding 3 months, can lead to unfavorable outcomes in cancer control.

scholarly journals Emerging intravesical therapies for the management of bacillus Calmette–Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer: Charting a path forward

2020 ◽  
Vol 14 (6) ◽  
Author(s):  
Ali Cyrus Chehroudi ◽  
Peter C. Black
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Radical Cystectomy ◽  
Clinical Trial Design ◽  
Standard Of Care ◽  
Invasive Bladder Cancer ◽  
Intravesical Therapy ◽  
Muscle Invasive Bladder Cancer ◽  
Bcg Failure ◽  
Muscle Invasive

Management of patients with cacillus Calmette–Guérin (BCG)-unresponsive, high-risk, non-muscle-invasive bladder cancer (NMIBC) presents a formidable clinical challenge that requires urologists to weigh the competing risks of progression during further intravesical therapy vs. the morbidity of radical cystectomy. The prognosis of high-risk NMIBC recurring after BCG depends on the adequacy of prior BCG, the timing of recurrence, and tumor histology. The standard of care is currently radical cystectomy, as effective salvage intravesical therapy has not been established. The development of bladder-sparing treatments has been hampered to date by inconsistent definitions of BCG failure and difficulties in identifying appropriate control treatments in clinical trials. Despite these limitations, the spectrum of salvage therapy is expanding to include enhanced intravesical chemo-, gene, and immuno-therapies. In this review, we provide an overview of these emerging agents in the context of our current understanding of BCG failure and the unique considerations for clinical trial design in this disease state.

scholarly journals RLC score (R status, lymphovascular invasion, C-reactive protein) predicts survival following radical cystectomy for muscle-invasive bladder cancer

2021 ◽  
Author(s):  
Julian Peter Struck ◽  
Marie Christine Hupe ◽  
Annika Heinisch ◽  
Tomasz Ozimek ◽  
Martin Johannes Peter Hennig ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Radical Cystectomy ◽  
Lymphovascular Invasion ◽  
Prognostic Score ◽  
Invasive Bladder Cancer ◽  
Lymph Node Status ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

Abstract Background CRP-based scoring systems were found to correlate with survival in patients with urooncologic diseases. Our retrospective single-centre study aimed to confirm CRP as a prognostic parameter in patients with bladder cancer (BCa) undergoing radical cystectomy (RC) and, based on the findings, to develop our own outcome score for muscle-invasive bladder cancer (MIBC) patients undergoing RC in order to identify patients with a high risk of mortality. Material and methods A total of 254 patients who underwent RC at Hanover Medical School between 1996 and 2007 were reviewed with a follow-up until autumn 2013. The clinicopathologic parameters assessed included age, co-morbidities, pre-/postoperative serum levels of CRP, leukocytes, haemoglobin, creatinine, urinary diversion, tumour grading, staging, lymph node status, lymph node density (LND), lymphovascular invasion (LVI), metastases, and resection margin status. The Chi-square test was used for univariate analyses. Kaplan-Meier estimates and the log-rank test were used for survival analyses. Regarding outcome, overall survival (OS) was assessed. Results The multivariate analysis excluding lymph node (LN)-positive and metastatic patients at time of RC showed a significant association of R status (R; p < 0.001), LVI (L; p = 0.021) and preoperative CRP level > 5 mg/l (C; p = 0.008) with OS. Based on these parameters, the RLC score was developed. The median OS in the intermediate, high-risk and very high-risk groups according to the RLC score was 62, 22, and 6.5 months, respectively. The score had a high predictive accuracy of 0.752. Conclusion The RLC score identifies BCa patients at a higher risk of overall mortality after RC. Overall, our study supports the role of CRP in prognostic score models for BCa.

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