World journal of urology · 2026
Clinical response outweighs baseline nodal stage in treatment selection and survival of clinically node-positive bladder cancer.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Albers L F, van Gennep E J, van der Heijden M S, Pos F J, van Rhijn B W G, Vis A N, Mertens L S
Аннотация
PURPOSE: Patients with clinically node-positive bladder cancer represent a heterogeneous group with overall poor prognosis. Treatment recommendations within the guidelines remain ill-defined. This study evaluates whether clinical response to initial systemic therapy and baseline clinical nodal stage were associated with subsequent treatment decisions and survival outcomes.
METHODS: A retrospective, multicenter cohort study was performed, concerning patients identified within three large bladder cancer centres diagnosed with lymph-node-positive bladder cancer (cN1-3). The primary objective was to assess whether clinical response to initial systemic therapy was associated subsequent treatment decisions (either no further treatment or radical local therapy; radical cystectomy or (chemo)radiation) and was associated with overall survival. The prognostic impact of lymph-node status and type of local radical treatment was assessed.
RESULTS: In 259 patients with lymph-node-positive bladder cancer (median age 64.9; 71%male; 44.8% cN2-3), those with clinical response (complete or partial response) to initial systemic therapy (p < 0.001) more often proceeded to radical local treatment, whereas the cN-status was not associated with treatment decision. Whether radical cystectomy or (chemo)radiation was chosen as local treatment was not influenced by clinical response (p = 0.57). Compared with responders, non-responders had significantly worse overall survival (HR 1.77, 95% CI 1.09-2.88; p = 0.02). Initial cN-stage and type of radical treatment were not independently associated with survival.
CONCLUSIONS: In this retrospective cohort, clinical response to initial systemic therapy, rather than baseline nodal stage, was associated with allocation to radical local treatment and with improved survival. These findings support response-adapted decision-making in node-positive bladder cancer and warrant prospective validation.
METHODS: A retrospective, multicenter cohort study was performed, concerning patients identified within three large bladder cancer centres diagnosed with lymph-node-positive bladder cancer (cN1-3). The primary objective was to assess whether clinical response to initial systemic therapy was associated subsequent treatment decisions (either no further treatment or radical local therapy; radical cystectomy or (chemo)radiation) and was associated with overall survival. The prognostic impact of lymph-node status and type of local radical treatment was assessed.
RESULTS: In 259 patients with lymph-node-positive bladder cancer (median age 64.9; 71%male; 44.8% cN2-3), those with clinical response (complete or partial response) to initial systemic therapy (p < 0.001) more often proceeded to radical local treatment, whereas the cN-status was not associated with treatment decision. Whether radical cystectomy or (chemo)radiation was chosen as local treatment was not influenced by clinical response (p = 0.57). Compared with responders, non-responders had significantly worse overall survival (HR 1.77, 95% CI 1.09-2.88; p = 0.02). Initial cN-stage and type of radical treatment were not independently associated with survival.
CONCLUSIONS: In this retrospective cohort, clinical response to initial systemic therapy, rather than baseline nodal stage, was associated with allocation to radical local treatment and with improved survival. These findings support response-adapted decision-making in node-positive bladder cancer and warrant prospective validation.