Comparative Assessment of Chemotherapy Followed by Consolidative Radical Cystectomy Versus Chemoradiation for Clinically Node-Positive Urothelial Carcinoma of the Bladder

Context: Patients with bladder cancer and clinically positive pelvic lymph nodes (cN+) have poor prognosis, and the optimal definitive treatment method remains controversial. Objective: To compare survival outcomes between chemotherapy followed by radical cystectomy (RC) and chemoradiation (CRT) in...

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Detalles Bibliográficos
Autores: Ślusarczyk, Aleksander|||0000-0002-4344-0191, Contieri, Roberto|||0000-0001-7011-0537, Longoni, Mattia, Miszczyk, Marcin|||0000-0002-4375-0827, Krajewski, Wojciech, Laukhtina, Ekaterina|||0000-0002-8953-0272, Del Giudice, Francesco|||0000-0003-3865-5988, Gallioli, Andrea|||0000-0002-3316-5691, Pradere, Benjamin|||0000-0002-7768-8558, Boorjian, Stephen A., Moschini, Marco|||0000-0002-3084-2458, Scilipoti, Pietro, Angelis, Mario De, Rajwa, Pawel|||0000-0003-4073-6584, Shah, Paras, Radziszewski, Piotr
Tipo de recurso: artículo
Fecha de publicación:2025
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:dnet:uabarcelona_::e2155199bb70ea23ea2af4d69696a902
Acceso en línea:https://ddd.uab.cat/record/328737
https://dx.doi.org/urn:doi:10.1016/j.clgc.2025.102399
Access Level:acceso abierto
Palabra clave:Chemoradiation
Clinically-positive lymph nodes
Radical cystectomy
Survival
Urinary bladder neoplasms
Urothelial carcinoma
Descripción
Sumario:Context: Patients with bladder cancer and clinically positive pelvic lymph nodes (cN+) have poor prognosis, and the optimal definitive treatment method remains controversial. Objective: To compare survival outcomes between chemotherapy followed by radical cystectomy (RC) and chemoradiation (CRT) in patients with cN+ bladder cancer. Methods: We queried the Surveillance, Epidemiology, and End Results (2000-2021) database to identify patients with cN+ bladder cancer treated with CRT or chemotherapy and RC. Cumulative incidence functions, Fine-Gray model, and Cox proportional hazards were used for the survival analysis. Inverse probability treatment weighting (IPTW) was used to adjust for confounders. The primary endpoints were cancer-specific mortality (CSM) and all-cause mortality (ACM). Results: Among 552 patients identified, 175 (32%) received CRT and 377 (68%) underwent chemotherapy plus RC, and 5-year ACM was 75% (95% confidence interval [CI]: 71%-78%). RC and CRT were associated with 5-year CSM of 62% (95% CI: 57%-67%) and 72% (95% CI: 65%-78%), and 5-year ACM of 70% (95% CI: 65%-75%) and 85% (95% CI: 75%-90%), respectively. After IPTW, on multivariable Cox proportional hazard analysis adjusted for nodal and tumor staging, age, gender, tumor size and race, RC was associated with a significantly lower risk of CSM (hazard ratio [HR]: 0.47, 95% CI: 0.37-0.60, P <.001) and ACM (HR: 0.53, 95% CI: 0.46-0.60, P <.001). Conclusions: Patients with cN+ bladder cancer who received CRT had a worse prognosis compared to those who underwent chemotherapy followed by RC. The incorporation of more effective systemic therapies is required to improve outcomes, as in our analysis, only one in four cN+ patients survived beyond 5 years.

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