Prognostic Implications of Patients With Clinically Node Positive Bladder Cancer Undergoing Radical Cystectomy

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Clinically node-positive (cN+) bladder cancer (BCa) presents diverse biological and prognostic profiles.
• Systemic therapy is increasingly central to managing cN+ BCa.
• Understanding oncological outcomes after radical cystectomy (RC) with perioperative systemic therapy is crucial.

Purpose of the Study:

• To examine oncological outcomes in patients with cN+ BCa undergoing RC.
• To evaluate the impact of perioperative systemic therapy on survival and mortality.
• To assess the prognostic significance of pathological response after treatment.

Main Methods:

• Retrospective analysis of a multicenter database (1067 patients) with cTanyN+M0 BCa undergoing RC.
• Inclusion criteria: cN1-2 disease, treatment between 2006-2023.
• Kaplan-Meier curves for overall survival (OS), competing risk cumulative incidence for cancer-specific mortality (CSM), and multivariable Cox regression models (MCR) were used.

Main Results:

• 589 patients met inclusion criteria; 189 received preoperative systemic treatment (PST), 115 had RC + adjuvant therapy (AT).
• Three-year OS was 69% for PST+RC, 55% for RC+AT, and 55% for RC alone. PST+RC was associated with lower all-cause mortality (HR: 0.67, P=.042).
• Pathological complete response (pCR), partial response (pPR), and pN0 status were significantly associated with lower risks of all-cause and cancer-specific mortality.

Conclusions:

• Patients with cN+ BCa undergoing surgery have varied oncological outcomes.
• Preoperative systemic therapy (PST) and adjuvant therapy (AT) are associated with improved overall survival (OS).
• Pathological response (pCR, pPR, pN0) is a significant prognostic indicator, supporting risk stratification and personalized care.