The impact of treatment modality on survival in patients with clinical node-positive bladder cancer: results from a multicenter collaboration: World Journal of Urology

L. Afferi, S. Zamboni, R.J. Karnes, F. Roghmann, P. Sargos, F. Montorsi, A. Briganti, A. Gallina, A. Mattei, G.B. Schulz, K. Hendricksen, C.S. Voskuilen, M. Rink, C. Poyet, O. De Cobelli, E. di Trapani, C. Simeone, M. Soligo, G. Simone, G. TudertiM. Alvarez-Maestro, L. Martínez-Piñeiro, A. Aziz, S.F. Shariat, M. Abufaraj, E. Xylinas, M. Moschini, Urothelial Carcinoma Working Group the European Association of Urology-Young Academic Urologists (EAU-YAU)

Research output: Contribution to journalArticlepeer-review


Purpose: To assess the impact of perioperative chemotherapy on survival in cN+ BCa patients and analyze it according to the pN status. Methods: A retrospective analysis was conducted on 639 BCa patients with cTanyN1-3M0 BCa treated with radical cystectomy (RC) and bilateral lymph node dissection (LND) with or without perioperative chemotherapy in ten tertiary referral centers from 1990 to 2017. Selected cN+ patients received induction chemotherapy (IC), whereas adjuvant chemotherapy (ACT) was delivered to selected pN+ patients. Univariable and multivariable Cox regression analyses were used to predict overall mortality (OM) after surgery, adjusting for clinicopathological confounders. Kaplan–Meier analyses assessed OM according to the treatment modality. Results: Overall, 356 (56%) patients were treated with surgery alone, 155 (24%) with IC followed by surgery, and 128 (20%) with ACT following surgery. Over a median follow-up of 25 months, 316 deaths were recorded. At univariable analysis, patients treated with IC and surgery had lower OM both considering cN+ [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.49–0.87, p = 0.004] and cN+pN− patients (HR 0.61, 95% CI 0.37–0.99, p = 0.05) compared to those treated with surgery alone. cN+pN+ patients treated with ACT experienced lower OM compared to those treated with IC or surgery alone at multivariable analysis (HR 0.40, 95% CI 0.22–0.74, p = 0.003). Conclusion: Patients with cTany cN+ cM0 BCa benefit more in terms of OS when treated with IC followed by RC + LND compared to RC + LND alone, regardless of LNMs at final histopathology examination. More data are needed to assess the role of ACT in the management of cN+ patients. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
Original languageEnglish
Pages (from-to)443-451
Number of pages9
JournalWorld J. Urol.
Issue number2
Publication statusPublished - 2021


  • Bladder cancer
  • Clinical metastases
  • Induction chemotherapy
  • Multimodal treatment
  • Radical cystectomy
  • Urothelial cancer
  • adjuvant chemotherapy
  • aged
  • bladder tumor
  • clinical trial
  • cystectomy
  • female
  • human
  • induction chemotherapy
  • lymph node dissection
  • lymph node metastasis
  • male
  • middle aged
  • mortality
  • multicenter study
  • pathology
  • retrospective study
  • survival rate
  • Aged
  • Chemotherapy, Adjuvant
  • Cystectomy
  • Female
  • Humans
  • Induction Chemotherapy
  • Lymph Node Excision
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Retrospective Studies
  • Survival Rate
  • Urinary Bladder Neoplasms


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