Prognostic Indicators Identified for Bladder Cancer With Isolated Lymph Node Metastasis

By Zachary Bessette - December 6, 2022

A new study published in Urologic Oncology: Seminars and Original Investigations sheds light on the natural history and outcomes of urothelial carcinoma of the bladder (UCB) with isolated lymph node metastasis after surgical resection.

While patients with UCB and pathologic lymph node involvement have a poor prognosis, some patients have experienced durable survival following surgical resection. To date, data that describe the natural history of UCB in patients with isolated lymph node involvement (cN0pN+) following radical cystectomy with pelvic lymph node dissection are limited.

Boris Gershman, MD, of Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues sought to examine the natural history and survival outcomes of cN0pN+ UCB after surgical resection. Utilizing the National Cancer Database, researchers identified 2884 patients from 2006 to 2015 who underwent radical cystectomy with pelvic lymph node dissection. They evaluated the associations of baseline characteristics with all-cause mortality using Cox regression.

Of the patient sample, 42% had pN1 disease and 58% had pN2-3 disease. A total of 21% (n=606) received multiagent neoadjuvant chemotherapy and 41% (n=1172) received adjuvant chemotherapy. Researchers noted that a median of 15 lymph nodes were removed during pelvic dissection.

The reported 5- and 7-year overall survival for the patient sample was 20% and 17%, respectively. Patients surviving ≤5 years had lower pN stage (59% vs 42%) and lower pT stage (41% vs 22%).

Multivariable analysis showed higher pT stage, higher pN stage, and increasing lymph node density were strongly associated with increased all-cause mortality. Patients who underwent adjuvant chemotherapy experienced reduced all-cause mortality, researchers added.

“pT and pN stage represent important prognostic characteristics, while administration of adjuvant chemotherapy represents a potential therapeutic intervention associated with improved all-cause mortality,” researchers concluded.