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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2021.365    [Accepted]
The Prognosis and the Role of Adjuvant Chemotherapy for Node-Positive Bladder Cancer Treated with Neoadjuvant Chemotherapy Followed by Surgery
Hyehyun Jeong1, Kye Jin Park2, Yong-jun Lee1,3, Hyung-Don Kim1, Jwa Hoon Kim1,4, Shinkyo Yoon1, Bumsik Hong5, Jae Lyun Lee1
1Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
3Department of Internal Medicine Division of Oncology, Haeundae Paik Hospital Cancer Center, Inje University College of Medicine, Busan, Korea
4Division of Oncology/Hematology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
5Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Correspondence  Jae Lyun Lee ,Tel: 82-2-3010-5977, Fax: 82-2-3010-6961, Email: jaelyun@amc.seoul.kr
Received: March 21, 2021;  Accepted: May 5, 2021.  Published online: May 6, 2021.
ABSTRACT
Purpose
This study aims to evaluate the prognosis of pathologically node-positive bladder cancer after neoadjuvant chemotherapy, the role of adjuvant chemotherapy in these patients, and the value of preoperative clinical evaluation for lymph node metastases.
Materials and Methods
Patients who received neoadjuvant chemotherapy followed by partial/radical cystectomy and had pathologically confirmed lymph node metastases between Jan 2007 and Dec 2019 were identified and analysed.
Results
A total of 53 patients were included in the study. The median age was 61 years (range, 34–81) with males comprising 86.8%. Among the 52 patients with post-neoadjuvant/pre-operative CT results, only 33 patients (63.5%) were considered positive for lymph node metastasis. Sixteen patients (30.2%) received adjuvant chemotherapy (AC group), and 37 patients did not (no AC group). With the median follow-up duration of 67.7 months, the median recurrence-free survival (RFS) and the median overall survival (OS) was 8.5 months and 16.2 months, respectively. The 2-year RFS and OS rates were 23.3% and 34.6%, respectively. RFS and OS did not differ between the AC group and no AC group (median RFS, 8.8 vs. 6.8 months, p=0.772; median OS, 16.1 vs. 16.3 months, p=0.479). Thirty-eight patients (71.7%) experienced recurrence. Distant metastases were the dominant pattern of failure in both the AC group (91.7%) and no AC group (76.9%).
Conclusion
Patients with lymph node-positive disease after neoadjuvant chemotherapy followed by surgery showed high recurrence rates with limited survival outcomes. Little benefit was observed with the addition of adjuvant chemotherapy.
Key words: Urinary Bladder Neoplasms, Neoadjuvant Therapy, Chemotherapy, Adjuvant, Lymphatic Metastasis
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