Journal article

Lack of Effectiveness of Postchemotherapy Lymphadenectomy in Bladder Cancer Patients with Clinical Evidence of Metastatic Pelvic or Retroperitoneal Lymph Nodes Only: A Propensity Score-based Analysis.

  • Necchi A Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. Electronic address: andrea.necchi@istitutotumori.mi.it.
  • Mariani L Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
  • Lo Vullo S Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
  • Yu EY University of Washington, Seattle, WA, USA.
  • Woods ME University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, NC, USA.
  • Wong YN Fox Chase Cancer Center, Philadelphia, PA, USA.
  • Harshman LC Dana-Farber Cancer Institute, Boston, MA, USA.
  • Alva A University of Michigan, Ann Arbor, MI, USA.
  • Sternberg CN San Camillo Forlanini Hospital, Rome, Italy.
  • Bamias A University of Athens, Athens, Greece.
  • Grivas P Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
  • Koshkin VS Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
  • Roghmann F Ruhr-University Bochum, Marien Hospital Herne, Herne, Germany.
  • Dobruch J Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland.
  • Eigl BJ British Columbia Cancer Agency, Vancouver, BC, Canada.
  • Nappi L British Columbia Cancer Agency, Vancouver, BC, Canada.
  • Milowsky MI University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, NC, USA.
  • Niegisch G Heinrich-Heine-University, Medical faculty, Department of Urology, Düsseldorf, Germany.
  • Pal SK City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
  • De Giorgi U IRCCS Istituto Scientifico Romagnolo per lo studio e la Cura dei Tumori, Meldola, Italy.
  • Recine F IRCCS Istituto Scientifico Romagnolo per lo studio e la Cura dei Tumori, Meldola, Italy.
  • Vaishampayan U Karmanos Cancer Institute, Detroit, MI, USA.
  • Berthold DD Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
  • Bowles DW Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, CO, USA.
  • Baniel J Rabin Medical Center, Petach Tikva, Israel.
  • Theodore C Hospital Foch, Suresnes, France.
  • Ladoire S Center Georges-François Leclerc, Dijon, France.
  • Srinivas S Stanford University School of Medicine, Stanford, CA, USA.
  • Agarwal N University of Utah, Salt Lake City, UT, USA.
  • Crabb S University of Southampton, Southampton, United Kingdom.
  • Sridhar S Princess Margaret Hospital, University Health Network, Toronto, Canada.
  • Golshayan AR Medical University of South Carolina, Charleston, SC, USA.
  • Ohlmann C Saarland University, Homburg, Germany.
  • Xylinas E Cochin Hospital, Assistance-Publique Hôpitaux de Paris, Paris Descartes University, Paris, France.
  • Powles T Barts Health and the Royal Free NHS Trust, Queen Mary University of London, London, UK.
  • Rosenberg JE Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
  • Bellmunt J Dana-Farber Cancer Institute, Boston, MA, USA.
  • van Rhijn B The Netherlands Cancer Institute, Amsterdam, The Netherlands.
  • Galsky MD Mount Sinai School of Medicine, Tisch Cancer Institute, New York, NY, USA.
  • Hendricksen K The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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  • 2017-07-30
Published in:
  • European urology focus. - 2019
English BACKGROUND
Limited data is available on the role, and extent of, postchemotherapy lymphadenectomy (PC-LND) in patients with clinical evidence of pelvic (cN1-3) or retroperitoneal (RP) lymph node spread from urothelial bladder carcinoma.


OBJECTIVE
To compare the outcomes of operated versus nonoperated patients after first-line chemotherapy.


DESIGN, SETTING, AND PARTICIPANTS
Data from 34 centers was collected, totaling 522 patients, treated between January 2000 and June 2015. Criteria for patient selection were the following: bladder primary tumor, lymph node metastases (pelvic±RP) only, first-line platinum-based chemotherapy given.


INTERVENTION
LND (with cystectomy) versus observation after first-line chemotherapy for metastatic urothelial bladder carcinoma.


OUTCOME MEASURES AND STATISTICAL ANALYSIS
Overall survival (OS) was the primary endpoint. Multiple propensity score techniques were adopted, including 1:1 propensity score matching and inverse probability of treatment weighting. Additionally, the inverse probability of treatment weighting analysis was performed with the inclusion of the covariates, that is, with doubly robust estimation.


RESULTS AND LIMITATIONS
Overall, 242 (46.4%) patients received PC-LND and 280 (53.6%) observation after chemotherapy. There were 177 (33.9%) and 345 (66.1%) patients with either RP or pelvic LND only, respectively. Doubly robust estimation-adjusted comparison was not significant for improved OS for PC-LND (hazard ratio [HR]: 0.86, 95% confidence interval [CI]: 0.56-1.31, p=0.479), confirmed by matched analysis (HR: 0.91, 95% CI: 0.60-1.36, p=0.628). This was also observed in the RP subgroup (HR: 1.12, 95% CI: 0.68-1.84). The retrospective nature of the data and the heterogeneous patient population were the major limitations.


CONCLUSIONS
Although there were substantial differences between the two groups, after accounting for major confounders we report a nonsignificant OS difference with PC-LND compared with observation only. These findings may be hypothesis-generating for future prospective trials.


PATIENT SUMMARY
We found no differences in survival by adding postchemotherapy lymphadenectomy in patients with pelvic or retroperitoneal lymph node metastatic bladder cancer. The indication to perform postchemotherapy lymphadenectomy in the most suitable patients requires additional studies.
Language
  • English
Open access status
green
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Persistent URL
https://sonar.ch/global/documents/533
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