Differential Outcomes in Bladder Cancer After Neoadjuvant Chemotherapy: An International Multi-Institutional Study Comparing Isolated Nodal Disease vs Persistent Muscle-Invasive Disease

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology Pub Date : 2025-06-01 DOI:10.1016/j.urology.2025.04.022

Andres M. Acosta , Mohammed Saad , Alcides Chaux , Jennifer B. Gordetsky , Lan Zheng , Charles Guo , Mohamed Bikhet , Adeboye O. Osunkoya , Katrina Collins , Muhammad T. Idrees , Geert J.L.H. van Leenders , Pilar Gonzalez-Peramato , Kristine M. Cornejo , Michelle S. Hirsch , Chia-Sui Kao , Andres Matoso , Cristina Magi-Galluzzi , Soroush Rais-Bahrami

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引用次数: 0

Abstract

Objective

To evaluate clinical outcomes based on patterns of residual disease in patients undergoing cystectomy after neoadjuvant chemotherapy (NAC), focusing on those with residual tumor only in lymph nodes.

Methods

We retrospectively analyzed 174 patients who underwent post-NAC radical cystectomy between 2010 and 2023 at academic centers from the United States and Europe. Patients were stratified into two groups: those with isolated lymph node disease despite complete local response (n = 35) and those with persistent muscle-invasive or locally advanced disease without lymph node involvement (n = 139). Primary outcomes included recurrence, disease-specific mortality (DSM), and survival. Median follow-up was 27.0 months (interquartile range: 9.0-60.0).

Results

Recurrence occurred in 33% of patients, with higher risk in patients with residual disease only in lymph nodes compared to those with persistent disease in the bladder and negative lymph nodes (adjusted OR: 0.43, 95% CI: 0.20-0.95, P = .036). DSM was 24%, with no significant difference between groups (adjusted OR: 0.70, 95% CI: 0.29-1.64, P = .407). Disease-related events occurred in 41% of patients, with lower risk in the group with residual disease in the bladder (adjusted OR: 0.46, 95% CI: 0.21-0.99, P = .048). Survival analyses showed no significant differences in DSM between groups (HR: 1.03, 95% CI: 0.48-2.20, P = 0.947). Variant histology (present in 36% of cases) did not influence outcomes.

Conclusion

Patients with isolated lymph node disease, despite complete local response after NAC, demonstrate higher recurrence risk compared to those with persistent muscle-invasive disease, although this does not translate into survival differences. These findings suggest the need for risk-adapted surveillance strategies and consideration of additional therapeutic interventions in patients with isolated residual nodal disease.

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膀胱癌新辅助化疗后的差异结局：一项比较孤立性淋巴结疾病与持续性肌肉侵袭性疾病的国际多机构研究

目的：评价膀胱切除术患者新辅助化疗（NAC）后肿瘤残留模式的临床疗效，重点关注淋巴结残留肿瘤。方法：我们回顾性分析了2010年至2023年间在美国和欧洲的学术中心接受nac后根治性膀胱切除术的174例患者。患者被分为两组：局部完全缓解的孤立性淋巴结疾病患者（n=35）和持续的肌肉侵袭性或局部晚期疾病患者（n=139）。主要结局包括复发率、疾病特异性死亡率（DSM）和生存率。中位随访时间为27.0个月（四分位数范围：9.0 ~ 60.0）。结果：33%的患者发生复发，仅淋巴结残留病变患者的复发风险高于膀胱持续病变和淋巴结阴性患者（校正OR: 0.43, 95% CI: 0.20-0.95， P= 0.036）。DSM为24%，组间无显著差异（校正OR: 0.70, 95% CI: 0.29-1.64， P= 0.407）。41%的患者发生了疾病相关事件，膀胱残留疾病组的风险较低（校正OR: 0.46, 95% CI: 0.21-0.99， P= 0.048）。生存分析显示两组间DSM无显著差异（HR: 1.03, 95% CI: 0.48 ~ 2.20， P=0.947）。不同的组织学（36%的病例存在）不影响结果。结论：孤立性淋巴结疾病患者，尽管NAC后局部完全缓解，但与持续性肌肉侵袭性疾病患者相比，复发风险更高，尽管这并不转化为生存差异。这些发现表明，有必要采取适应风险的监测策略，并考虑对孤立性残余淋巴结病患者采取额外的治疗干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urology 医学-泌尿学与肾脏学

CiteScore

3.30

自引率

9.50%

发文量

716

审稿时长

59 days

期刊介绍： Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.