Comparative Assessment of Chemotherapy Followed by Consolidative Radical Cystectomy Versus Chemoradiation for Clinically Node-Positive Urothelial Carcinoma of the Bladder
This study compares outcomes between chemoradiation (CRT) and radical cystectomy (RC) with neoadjuvant chemotherapy in 552 patients with clinically node-positive (cN + ) invasive bladder cancer. Using SEER data and IPTW-adjusted survival analyses, we found that RC was associated with significantly l...
| Autores: | , , , , , , , , , , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2025 |
| País: | España |
| Institución: | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| Repositorio: | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| OAI Identifier: | oai:iibsantpau.fundanetsuite.com:p19693 |
| Acceso en línea: | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=19693 |
| Access Level: | acceso abierto |
| Palabra clave: | Chemoradiation Clinically-positive lymph nodes Radical cystectomy Survival Urinary bladder neoplasms Urothelial carcinoma |
| Sumario: | This study compares outcomes between chemoradiation (CRT) and radical cystectomy (RC) with neoadjuvant chemotherapy in 552 patients with clinically node-positive (cN + ) invasive bladder cancer. Using SEER data and IPTW-adjusted survival analyses, we found that RC was associated with significantly lower cancer-specific and all-cause mortality (ACM) compared to CRT (5-yr ACM 70% vs. 85%). Findings highlight the need for optimized systemic therapies, as long-term survival remains poor in this population. 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. (c) 2025 The Author(s).Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) |
|---|