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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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
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spelling Comparative Assessment of Chemotherapy Followed by Consolidative Radical Cystectomy Versus Chemoradiation for Clinically Node-Positive Urothelial Carcinoma of the BladderŚlusarczyk, Aleksander|||0000-0002-4344-0191Contieri, Roberto|||0000-0001-7011-0537Longoni, MattiaMiszczyk, Marcin|||0000-0002-4375-0827Krajewski, WojciechLaukhtina, Ekaterina|||0000-0002-8953-0272Del Giudice, Francesco|||0000-0003-3865-5988Gallioli, Andrea|||0000-0002-3316-5691Pradere, Benjamin|||0000-0002-7768-8558Boorjian, Stephen A.Moschini, Marco|||0000-0002-3084-2458Scilipoti, PietroAngelis, Mario DeRajwa, Pawel|||0000-0003-4073-6584Shah, ParasRadziszewski, PiotrChemoradiationClinically-positive lymph nodesRadical cystectomySurvivalUrinary bladder neoplasmsUrothelial carcinomaContext: 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.Universitat Autònoma de Barcelona. Departament de Medicina 22025-01-0120252025-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/328737https://dx.doi.org/urn:doi:10.1016/j.clgc.2025.102399reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:dnet:uabarcelona_::e2155199bb70ea23ea2af4d69696a9022026-06-06T12:50:31Z
dc.title.none.fl_str_mv Comparative Assessment of Chemotherapy Followed by Consolidative Radical Cystectomy Versus Chemoradiation for Clinically Node-Positive Urothelial Carcinoma of the Bladder
title Comparative Assessment of Chemotherapy Followed by Consolidative Radical Cystectomy Versus Chemoradiation for Clinically Node-Positive Urothelial Carcinoma of the Bladder
spellingShingle Comparative Assessment of Chemotherapy Followed by Consolidative Radical Cystectomy Versus Chemoradiation for Clinically Node-Positive Urothelial Carcinoma of the Bladder
Ślusarczyk, Aleksander|||0000-0002-4344-0191
Chemoradiation
Clinically-positive lymph nodes
Radical cystectomy
Survival
Urinary bladder neoplasms
Urothelial carcinoma
title_short Comparative Assessment of Chemotherapy Followed by Consolidative Radical Cystectomy Versus Chemoradiation for Clinically Node-Positive Urothelial Carcinoma of the Bladder
title_full Comparative Assessment of Chemotherapy Followed by Consolidative Radical Cystectomy Versus Chemoradiation for Clinically Node-Positive Urothelial Carcinoma of the Bladder
title_fullStr Comparative Assessment of Chemotherapy Followed by Consolidative Radical Cystectomy Versus Chemoradiation for Clinically Node-Positive Urothelial Carcinoma of the Bladder
title_full_unstemmed Comparative Assessment of Chemotherapy Followed by Consolidative Radical Cystectomy Versus Chemoradiation for Clinically Node-Positive Urothelial Carcinoma of the Bladder
title_sort Comparative Assessment of Chemotherapy Followed by Consolidative Radical Cystectomy Versus Chemoradiation for Clinically Node-Positive Urothelial Carcinoma of the Bladder
dc.creator.none.fl_str_mv 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
author Ślusarczyk, Aleksander|||0000-0002-4344-0191
author_facet 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
author_role author
author2 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
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universitat Autònoma de Barcelona. Departament de Medicina
dc.subject.none.fl_str_mv Chemoradiation
Clinically-positive lymph nodes
Radical cystectomy
Survival
Urinary bladder neoplasms
Urothelial carcinoma
topic Chemoradiation
Clinically-positive lymph nodes
Radical cystectomy
Survival
Urinary bladder neoplasms
Urothelial carcinoma
description 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.
publishDate 2025
dc.date.none.fl_str_mv 2
2025-01-01
2025
2025-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/328737
https://dx.doi.org/urn:doi:10.1016/j.clgc.2025.102399
url https://ddd.uab.cat/record/328737
https://dx.doi.org/urn:doi:10.1016/j.clgc.2025.102399
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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