Tags

Type your tag names separated by a space and hit enter

More Extensive Lymph Node Dissection Improves Survival Benefit of Radical Cystectomy in Metastatic Urothelial Carcinoma of the Bladder.
Clin Genitourin Cancer. 2019 04; 17(2):105-113.e2.CG

Abstract

BACKGROUND

Radical cystectomy (RC) may occasionally be performed in individuals with metastatic urothelial carcinoma of the bladder (mUCB). However, the role of lymph node dissection (LND) for such cases is unknown. Thus, we tested the effect of RC on cancer-specific mortality (CSM) and overall mortality in mUCB patients and the effect of LND and its extent on CSM.

PATIENTS AND METHODS

Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2013), we identified patients with mUCB who underwent RC with or without LND or non-RC management. Kaplan-Meier analyses and multivariable Cox regression models (CRMs) were used, after propensity score matching. The number of removed nodes best predicting CSM was identified using cubic splines and then was tested in multivariable CRMs.

RESULTS

Of 2314 patients, 319 (13.8%) underwent RC. After 2:1 propensity score matching, CSM-free survival was 14 versus 8 months (P < .001), and overall mortality-free survival was 12 versus 7 months (P < .001) for, respectively, RC and non-RC patients. In multivariable CRMs, lower CSM (hazard ratio = 0.48; P < .001) and lower overall mortality (hazard ratio = 0.49; P < .001) rates were recorded in RC patients. LND status did not affect CSM-free survival (13 vs. 10 months; P = .1). Cubic splines-derived cutoff of ≥ 13 number of removed nodes showed better CSM-free survival (20 vs. 11 months; P = .02) and reduced CSM in CRMs (hazard ratio = 0.67; P = .02).

CONCLUSION

Our study validates the survival benefit of RC in mUCB and highlights the importance of more extensive LND. These findings may corroborate the hypothesis of potential cytoreductive effect of surgery in the context of metastatic disease.

Authors+Show Affiliations

Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: eliomazzone@gmail.com.Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.Department of Urology, Medical University of Vienna, Vienna, Austria.Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30527745

Citation

Mazzone, Elio, et al. "More Extensive Lymph Node Dissection Improves Survival Benefit of Radical Cystectomy in Metastatic Urothelial Carcinoma of the Bladder." Clinical Genitourinary Cancer, vol. 17, no. 2, 2019, pp. 105-113.e2.
Mazzone E, Preisser F, Nazzani S, et al. More Extensive Lymph Node Dissection Improves Survival Benefit of Radical Cystectomy in Metastatic Urothelial Carcinoma of the Bladder. Clin Genitourin Cancer. 2019;17(2):105-113.e2.
Mazzone, E., Preisser, F., Nazzani, S., Tian, Z., Fossati, N., Gandaglia, G., Gallina, A., Soulieres, D., Tilki, D., Montorsi, F., Shariat, S. F., Saad, F., Briganti, A., & Karakiewicz, P. I. (2019). More Extensive Lymph Node Dissection Improves Survival Benefit of Radical Cystectomy in Metastatic Urothelial Carcinoma of the Bladder. Clinical Genitourinary Cancer, 17(2), 105-e2. https://doi.org/10.1016/j.clgc.2018.11.003
Mazzone E, et al. More Extensive Lymph Node Dissection Improves Survival Benefit of Radical Cystectomy in Metastatic Urothelial Carcinoma of the Bladder. Clin Genitourin Cancer. 2019;17(2):105-113.e2. PubMed PMID: 30527745.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - More Extensive Lymph Node Dissection Improves Survival Benefit of Radical Cystectomy in Metastatic Urothelial Carcinoma of the Bladder. AU - Mazzone,Elio, AU - Preisser,Felix, AU - Nazzani,Sebastiano, AU - Tian,Zhe, AU - Fossati,Nicola, AU - Gandaglia,Giorgio, AU - Gallina,Andrea, AU - Soulieres,Denis, AU - Tilki,Derya, AU - Montorsi,Francesco, AU - Shariat,Shahrokh F, AU - Saad,Fred, AU - Briganti,Alberto, AU - Karakiewicz,Pierre I, Y1 - 2018/11/17/ PY - 2018/09/16/received PY - 2018/11/08/revised PY - 2018/11/09/accepted PY - 2018/12/12/pubmed PY - 2020/2/25/medline PY - 2018/12/12/entrez KW - Cancer-specific mortality KW - Metastatic bladder cancer KW - Number of removed nodes KW - Propensity-score matching KW - SEER Program SP - 105 EP - 113.e2 JF - Clinical genitourinary cancer JO - Clin Genitourin Cancer VL - 17 IS - 2 N2 - BACKGROUND: Radical cystectomy (RC) may occasionally be performed in individuals with metastatic urothelial carcinoma of the bladder (mUCB). However, the role of lymph node dissection (LND) for such cases is unknown. Thus, we tested the effect of RC on cancer-specific mortality (CSM) and overall mortality in mUCB patients and the effect of LND and its extent on CSM. PATIENTS AND METHODS: Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2013), we identified patients with mUCB who underwent RC with or without LND or non-RC management. Kaplan-Meier analyses and multivariable Cox regression models (CRMs) were used, after propensity score matching. The number of removed nodes best predicting CSM was identified using cubic splines and then was tested in multivariable CRMs. RESULTS: Of 2314 patients, 319 (13.8%) underwent RC. After 2:1 propensity score matching, CSM-free survival was 14 versus 8 months (P < .001), and overall mortality-free survival was 12 versus 7 months (P < .001) for, respectively, RC and non-RC patients. In multivariable CRMs, lower CSM (hazard ratio = 0.48; P < .001) and lower overall mortality (hazard ratio = 0.49; P < .001) rates were recorded in RC patients. LND status did not affect CSM-free survival (13 vs. 10 months; P = .1). Cubic splines-derived cutoff of ≥ 13 number of removed nodes showed better CSM-free survival (20 vs. 11 months; P = .02) and reduced CSM in CRMs (hazard ratio = 0.67; P = .02). CONCLUSION: Our study validates the survival benefit of RC in mUCB and highlights the importance of more extensive LND. These findings may corroborate the hypothesis of potential cytoreductive effect of surgery in the context of metastatic disease. SN - 1938-0682 UR - https://www.unboundmedicine.com/medline/citation/30527745/More_Extensive_Lymph_Node_Dissection_Improves_Survival_Benefit_of_Radical_Cystectomy_in_Metastatic_Urothelial_Carcinoma_of_the_Bladder_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1558-7673(18)30678-5 DB - PRIME DP - Unbound Medicine ER -