gms | German Medical Science

Introduction: A recent meta-analysis has demonstrated a 25% relative risk reduction of death and an absolute survival benefit of 9% at 3 years for adjuvant chemotherapy following radical cystectomy (RCx) for lymph node positive bladder cancer. It was the aim of our analysis to identify predictors of survival following standard chemotherapy in lymph node positive bladder cancer.

Patients and Methods: A retrospective analysis of 156 consecutive patients with lymph node positive urothelial bladder cancer was performed. All patients underwent systemic chemotherapy with 4 cycles gemictabine/cisplatin 4 to 6 weeks after RCx. Median time to progression (TTP) and median survival time was evaluated. The prognostic significance of the number of positive lymph nodes, lymph node diameter, extranodal extension, bilateral lymph node involvement, pT stage, grade, tumor diameter, presence of lymphatic (LI) or vascular invasion (VI) was analysed. Statistical analysis was performed by uni- and multivariate analysis; median time to progression and survival time were calculated by the Kaplan-Meier method.

Results: Median follow-up is 6.5 (12 – 3.5) years, minimum follow-up is 36 months. Median survival time is 56 months, 56% of the patients died due to tumor progression. pT stage (p=0.002), tumor diameter (p=0.005), LI (p=0.0015) or VI (p=0.0028), lymph node diameter (p=0.026) and extranodal extension (p=0.0002) were significant risk factors associated with survival by univariate analysis. Neither the number or bilaterality of positive lymph nodes nor tumor grade were associated with survival time. On multivariate analysis only extranodal extension (p=0.001) and tumor diameter (p=0.05) remained significant and independent prognostic predictors. Median survival was 64 and 21 months in patients with or w/o extranodal extension (p = 0.0001), resp.; median survival was 81 and 28 months in patients w/o and with LI/VI (p = 0.001). In patients with extranodal extension or LI/VI adjuvant chemotherapy had no impact on survival.

Discussion: Analysis of multiple pathohistological and clinical parameters reveal that extranodal extension, primary tumor diameter and presence of LI/VI represent risk factors predicting survival following adjuvant chemotherapy in lymph node positive bladder cancer. Patients exhibiting these adverse factors might be considered for a more aggressive systemic approach.