JOURNAL ARTICLE

Impact of adjuvant chemotherapy on patients with lymph node metastasis at the time of radical cystectomy

Thomas J Guzzo, Matthew J Resnick, Daniel J Canter, Arturo Balandra, Meredith R Bergey, Laurie Magerfleisch, John E Tomaszewski, David J Vaughn, S Bruce Malkowicz
Canadian Journal of Urology 2010, 17 (6): 5465-71
21172112

INTRODUCTION: Radical cystectomy (RC) remains the gold standard treatment for patients with muscle-invasive bladder cancer. Unfortunately, a significant proportion of patients will have lymph node involvement at the time of RC. We set out to determine the impact of adjuvant cisplatin-based chemotherapy (AC) in a cohort of lymph node positive patients following RC.

PATIENTS AND METHODS: We reviewed our RC database and isolated patients with lymph node positive disease at the time of RC. Univariate and multivariable analysis was performed to identify predictors of poor outcome in patients receiving AC. Overall survival (OS), disease specific survival (DSS) and recurrence free survival (RFS) were calculated for those patients who received AC compared to those who did not.

RESULTS: Of the 316 patients, we identified 85 patients with metastatic lymph node involvement at the time of RC. Fifty-five (65%) of these patients received AC. Median follow up was 46 months. On multivariable analysis lymph node positive patients receiving AC had significantly improved OS, DSS and RFS compared to patients who did not receive AC (p = 0.031, p = 0.028, p = 0.004). The delivery of AC conferred the greatest recurrence-free, disease-specific, and overall survival advantages to those with lymph node densities (LND) of < 20% with (p = 0.016, p = 0.011, p = 0.007, respectively).

CONCLUSION: AC administered to patients with known lymph node metastasis conferred a significant survival advantage compared to observation. Furthermore, a LND of < 20% predicts of a more favorable response to AC. Further studies in larger patient populations are warranted to reveal the exact impact of AC in this subset of patients.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
21172112
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"