Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
World J Urol. 2022 Jan;40(1):111-118. doi: 10.1007/s00345-021-03839-7. Epub 2021 Sep 28.
Little is known about the prevalence of occult lymph node metastases (LNM) in muscle-invasive bladder cancer (MIBC) patients with pathological downstaging of the primary tumor. We aimed to estimate the prevalence of occult LNM in patients without residual MIBC at radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC) or neoadjuvant radiotherapy (NAR), and to assess overall survival (OS).
Patients with cT2-T4aN0M0 urothelial MIBC who underwent RC plus pelvic lymph node dissection (PLND) with curative intent between January 1995-December 2013 (retrospective Netherlands Cancer Registry (NCR) cohort) and November 2017-October 2019 (prospective NCR-BlaZIB cohort (acronym in Dutch: BlaaskankerZorg In Beeld; in English: Insight into bladder cancer care)) were identified from the nationwide NCR. The prevalence of occult LNM was calculated and OS of patients with <(y)pT2N0 vs. <(y)pT2N+ disease was estimated by the Kaplan-Meier method.
In total, 4657 patients from the NCR cohort and 760 patients from the NCR-BlaZIB cohort were included. Of 1374 patients downstaged to <(y)pT2, 4.3% (N = 59) had occult LNM 4.1% (N = 49) of patients with cT2-disease and 5.6% (N = 10) with cT3-4a-disease. This was 4.0% (N = 44) in patients without NAC or NAR, 4.5% (N = 10) in patients with NAC, and 13.5% (N = 5) in patients with NAR but number of patients treated with NAR and downstaged disease was small. The prevalence of <(y)pT2N+ disease was 4.2% (N = 48) in the NCR cohort and 4.6% (N = 11) in the NCR-BlaZIB cohort. For patients with <(y)pT2N+ and <(y)pT2N0, median OS was 3.5 years (95% CI 2.5-8.9) versus 12.9 years (95% CI 11.7-14.0), respectively.
Occult LNM were found in 4.3% of patients with cT2-4aN0M0 MIBC with (near-) complete downstaging of the primary tumor following RC plus PLND. This was regardless of NAC or clinical T-stage. Patients with occult LNM showed considerable worse survival. These results can help in counseling patients for bladder-sparing treatments.
对于原发性肿瘤病理降期的肌层浸润性膀胱癌（MIBC）患者，隐匿性淋巴结转移（LNM）的发生率知之甚少。我们旨在评估根治性膀胱切除术（RC）加盆腔淋巴结清扫术（PLND）治疗时，有无新辅助化疗（NAC）或新辅助放疗（NAR）的情况下，无残余 MIBC 患者隐匿性 LNM 的发生率，并评估总生存（OS）。
1995 年 1 月至 2013 年 12 月（回顾性荷兰癌症登记处（NCR）队列）和 2017 年 11 月至 2019 年 10 月（前瞻性 NCR-BlaZIB 队列）期间，接受 RC 加 PLND 治疗且具有治愈性意向的 cT2-T4aN0M0 尿路上皮 MIBC 患者被纳入研究。从全国性 NCR 中确定了来自 NCR 队列的 4657 名患者和来自 NCR-BlaZIB 队列的 760 名患者。在降期至 <(y)pT2 的 1374 名患者中，4.3%（N=59）存在隐匿性 LNM，4.1%（N=49）为 cT2 疾病患者，5.6%（N=10）为 cT3-4a 疾病患者。这是无 NAC 或 NAR 患者的 4.0%（N=44），NAC 患者的 4.5%（N=10）和 NAR 患者的 13.5%（N=5），但接受 NAR 治疗和降期疾病的患者数量较少。NCR 队列中 <(y)pT2N+ 疾病的发生率为 4.2%（N=48），NCR-BlaZIB 队列中为 4.6%（N=11）。对于 <(y)pT2N+ 和 <(y)pT2N0 患者，中位 OS 分别为 3.5 年（95%CI 2.5-8.9）和 12.9 年（95%CI 11.7-14.0）。
在 RC 加 PLND 后原发性肿瘤（近乎）完全降期的 cT2-4aN0M0 MIBC 患者中，发现了 4.3%的隐匿性 LNM。这与 NAC 或临床 T 期无关。隐匿性 LNM 患者的生存情况明显较差。这些结果有助于为患者提供保留膀胱治疗的咨询。
