Objectives
To evaluate the risk of occult nodal metastasis in patients with muscle invasive bladder
cancer who exhibit a complete or partial clinical response to neoadjuvant chemotherapy
(NAC) and assess a potential role for “bladder sparing” management given that the
gold standard treatment, radical cystectomy (RC), is associated with high morbidity.
Methods
We queried the National Cancer Database for bladder cancer from 2004 to 2013 including
patients with cT2-4aN0M0 bladder cancer who underwent multiagent NAC followed by RC
and pelvic lymphadenectomy and excluding patients with nonurothelial predominant histology
and those undergoing partial cystectomy. Student's t test was used to evaluate patients’ demographics, presence of co-morbid conditions,
and pathologic findings, notably the presence of lymphovascular invasion and variant
histology.
Results
We identified 17,917 patients who underwent RC. Of these, 14.9% (n = 2673) received NAC before RC. About 13.1% and 14.5% of patients had complete (ypT0)
and partial (ypTa, Tis, and T1) pathologic response, respectively. These 14.7% of
cT2, 9.0% of cT3, and 6.9% of cT4 patients exhibited pT0 status on final pathology.
And 4.9% of complete and 5.4% of partial responders demonstrated occult nodal metastases.
Age, sex, ethnicity, the presence of co-morbidities, LVI, and variant histology were
not significantly associated with occult nodal metastasis.
Conclusion
While bladder preservation may be a viable option in patients who are carefully selected
and closely followed after NAC, patients undergoing NAC may be at risk of occult disease
outside of the bladder despite an otherwise clinical complete response diagnosed with
cross-sectional imaging, cystoscopy, TURBT, and cytology.
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Article info
Publication history
Published online: April 05, 2020
Accepted:
March 12,
2020
Received:
January 21,
2020
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
