Occult lymph node metastases in patients without residual muscle-invasive bladder cancer at radical cystectomy with or without neoadjuvant chemotherapy: a nationwide study of 5417 patients
van Hoogstraten, L M C; van Gennep, E J; Kiemeney, L A L M; Witjes, J A; Voskuilen, C S; Deelen, M; Mertens, L S; Meijer, R P; Boormans, J L; Robbrecht, D G J; Beerepoot, L V; Verhoeven, R H A; Ripping, T M; van Rhijn, B W G; Aben, K K H; Hermans, T J N; BlaZIB Study Group
(2022) World Journal of Urology, volume 40, issue 1, pp. 111 - 118
(Article)
Abstract
PURPOSE: Little is known about the prevalence of occult lymph node metastases (LNM) in muscle-invasive bladder cancer (MIBC) patients with pathological downstaging of the primary tumor. We aimed to estimate the prevalence of occult LNM in patients without residual MIBC at radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC)
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or neoadjuvant radiotherapy (NAR), and to assess overall survival (OS). METHODS: Patients with cT2-T4aN0M0 urothelial MIBC who underwent RC plus pelvic lymph node dissection (PLND) with curative intent between January 1995-December 2013 (retrospective Netherlands Cancer Registry (NCR) cohort) and November 2017-October 2019 (prospective NCR-BlaZIB cohort (acronym in Dutch: BlaaskankerZorg In Beeld; in English: Insight into bladder cancer care)) were identified from the nationwide NCR. The prevalence of occult LNM was calculated and OS of patients with <(y)pT2N0 vs. <(y)pT2N+ disease was estimated by the Kaplan-Meier method. RESULTS: In total, 4657 patients from the NCR cohort and 760 patients from the NCR-BlaZIB cohort were included. Of 1374 patients downstaged to <(y)pT2, 4.3% (N = 59) had occult LNM 4.1% (N = 49) of patients with cT2-disease and 5.6% (N = 10) with cT3-4a-disease. This was 4.0% (N = 44) in patients without NAC or NAR, 4.5% (N = 10) in patients with NAC, and 13.5% (N = 5) in patients with NAR but number of patients treated with NAR and downstaged disease was small. The prevalence of <(y)pT2N+ disease was 4.2% (N = 48) in the NCR cohort and 4.6% (N = 11) in the NCR-BlaZIB cohort. For patients with <(y)pT2N+ and <(y)pT2N0, median OS was 3.5 years (95% CI 2.5-8.9) versus 12.9 years (95% CI 11.7-14.0), respectively. CONCLUSION: Occult LNM were found in 4.3% of patients with cT2-4aN0M0 MIBC with (near-) complete downstaging of the primary tumor following RC plus PLND. This was regardless of NAC or clinical T-stage. Patients with occult LNM showed considerable worse survival. These results can help in counseling patients for bladder-sparing treatments.
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Keywords: Aged, Bladder cancer, Carcinoma, Transitional Cell/drug therapy, Cystectomy/methods, Downstaging, Humans, Lymph node metastases, Lymphatic Metastasis, Neoadjuvant Therapy, Neoadjuvant chemotherapy, Neoplasm Invasiveness, Neoplasm, Residual, Netherlands, Prospective Studies, Radical cystectomy, Retrospective Studies, Urinary Bladder Neoplasms/drug therapy, Journal Article
ISSN: 0724-4983
Publisher: Springer Verlag
Note: Funding Information: The BlaZIB study is funded by the Dutch Cancer Society (KWF, IKNL 2015–7914). The funding agency had no further role in this study. Funding Information: The authors thank the registration team of the Netherlands Comprehensive Cancer Organisation (IKNL) for the collection of data for the Netherlands Cancer Registry as well as IKNL staff for their help, the Dutch Uro-Oncology Study group (DUOS) and the Dutch Cancer Society (KWF Kankerbestrijding) for the financial support and the Dutch Pathology Registry (PALGA) for their support in the data acquisition (in particular, Hester H. van Boven, MD, PhD, Pathologist at the Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital and Rinus Voorham, PALGA data manager). The members of the BlaZIB study group are: Katja K.H. Aben (PI), PhD (Netherlands Comprehensive Cancer Organisation, Radboud University Medical Center). Lambertus A.L.M. Kiemeney (PI), PhD, Prof (Radboud University Medical Center). J. Alfred Witjes (PI), MD, PhD, Prof (Radboud University Medical Center). Lisa M.C. van Hoogstraten, MSc (Netherlands Comprehensive Cancer Organisation). Theodora M. Ripping, PhD (Netherlands Comprehensive Cancer Organisation). Joost Boormans, MD, PhD (Erasmus Medical Center). Catharina A. Goossens-Laan, MD, PhD (Alrijne hospital). Sipke Helder (Patient association ‘Leven met blaas- of nierkanker). Maarten C.C.M. Hulshof, MD, PhD (Amsterdam University Medical Centers, University of Amsterdam). Geert J.L.H. van Leenders, MD, PhD (Erasmus Medical Center). Anna M. Leliveld, MD, PhD (University Medical Center Groningen). Richard P. Meijer, MD, PhD (University Medical Center Utrecht). Sasja F. Mulder, MD, PhD (Radboud University Medical Center). Ronald I. Nooter (Franciscus Gasthuis & Vlietland hospital). Juus L. Noteboom, MD, PhD (University Medical Center Utrecht). Jorg R. Oddens, MD, PhD (Amsterdam University Medical Centers, University of Amsterdam). Theo M. de Reijke, MD, PhD (Amsterdam University Medical Centers, University of Amsterdam). Tineke J. Smilde, MD, PhD (Jeroen Bosch ziekenhuis). Guus W.J. Venderbosch (Patient association ‘Leven met blaas- of nierkanker’). Antoine G. van der Heijden, MD, PhD (Radboud University Medical Center). Michiel S. van der Heijden, MD, PhD (Netherlands Cancer Institute). Reindert J.A. van Moorselaar, MD, PhD, Prof (Amsterdam University Medical Centers, Vrije Universiteit Amsterdam). Bas W.G. van Rhijn, MD, PhD, FEBU (Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital). Joep G.H. van Roermund, MD, PhD (Maastricht University Medical Center). Bart P. Wijsman, MD, PhD (Elisabeth-TweeSteden Ziekenhuis) Publisher Copyright: © 2021, The Author(s).
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