Treatment and prognosis in patients with transitional cell carcinoma of the urinary bladder metastasizing to regional lymph nodes
https://doi.org/10.17650/1726-9776-2007-3-4-30-35
Abstract
Objective: to assess the results of treatment and to identify the predictors of survival in patients with transitional cell carcinoma of the urinary bladder with regional lymph node metastasis.
Material and methods. A retrospective analysis of 56 patients with transitional cell carcinoma of the bladder (pT1—4aN1—2M0—1,) who underwent radical cystectomy at the N.N. Blokhin Russian Cancer Center between 1980 and 2005 was performed. Their median age was 58.6 years; males and females were 85.7 and 14.3%, respectively. Studer`s (19.7%), Bricker`s (73.2%) procedures and ureterocutaneostomy (7.1%) were used for urinary divertion. Thirty-six (64.3%) of the 56 patients received additional treatment: neoadjuvant chemotherapy (CT) (n = 2 (3.6%)), adjuvant therapy (n = 32 (57.1%)); CT (n = 24 (42.8%)), and radiotherapy (n = 6 (10.7%)), chemoradiation therapy (n = 2 (3.6%)), and neo- and adjuvant CT (n = 2 (3.6%)). The median follow-up was 21.7 months (1-97.6 months).
Results. The effect of neoadjuvant CT was assessed as stabilization in all cases. Less than 15 lymph nodes were removed in 27 (48.2%), 15 lymph nodes or more were removed in 29 (51.8%) patients. The category pN+ was diagnosed in all cases: pN1 in 19 (33.9%), pN2 in 37 (66.1%). Involvement of nonregional (paraaortic) lymph nodes (pM+) was detected in 3 (5.4%) patients. Recurrences developed in 41 (71.9%) of the 56 patients on an average of 11.8 months after termination of treatment: localized regional and distant metastases in 3 (5.3%) and 35 (61.4%) patients, respectively; their combination in 3 (5.3%). In all 56 patients, overall, tumor-specific, and relapse-free 5-year survival was 32.1, 34.0, and 17.9%, respectively. Univariate analysis indicated that a history of superficial carcinoma (p = 0.036), as well as nonregional lymphogenic metastases (p = 0.036), and additional treatment (p = 0.020) were significant predictors. There was a trend for better survival in patients with pT < 3a (p = 0.056), after removal of more than 15 lymph nodes (p = 0.084), Bricker's operation (p = 0.055), and adjuvant therapy (p = 0.065).
Conclusion. Multimodal approach for transitional cell carcinoma of the urinary bladder with regional metastases improves tumor-specific 5-year survival as compared with that after radical cystectomy alone.
About the Authors
R. V. Khabalov
N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences
Russian Federation
Russian Federation
Department of Urology
Moscow
V. B. Matveev
N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences
Russian Federation
Russian Federation
Department of Urology
Moscow
M. I. Volkova
N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences
Russian Federation
Russian Federation
Department of Urology
Moscow
D. A. Nosov
N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences
Russian Federation
Russian Federation
Department of Urology
Moscow
References
1. Paik M.L., Scolieri M.J., Brown S.L. et al. Limitations of computerized tomography in staging invasive bladder cancer before radical cystectomy. J Urol 2000;163(6):1693—6.
2. Jaske G., Algaba F., Fossa S. et al. EAU guidelines on bladder cancer. Muscle invasive and metastatic. 2004.
3. Fleishmann A., Thalmann G.N., Markwalder R. et al. Prognostic implications of extracapsular extension of pelvic lymph node metastases in uroyhelial carcinoma of the bladder. Am J Surg Pathol 2005;29(1):89—95.
4. Herr H.W. Superiority of ratio based lymph node staging for bladder cancer. J Urol 2003;169(3):943—5.
5. Bajorin D.F., Dodd P.M., Mazumdar M. et al. Long-term survival in metastatic transitional cell carcinoma and prognostic factors predicting outcome of therapy. J Clin Oncol 1999;17:3173—81.
6. Saxman S.B., Propert K.J., Einhorn L.H. et al. Long-term follow-up of a phase III intergroup study of cisplatine alone or in combination with VAC in patients with metastatic urotelial carcinoma. J Clin Oncol 1997;15:2564—9.
7. Kerr W.S., Colby F.H. Pelvic lymph node dissection and total cystectomy in the treatment of carcinoma of the bladder. J Urol 1950:63:842—51.
8. Whitmore W., Marshall V. Radical total cystectomy for cancer of the bladder. J Urol; 1962:853—68.
9. Herr H.W., Donat S.M. Invasive Bladder Cancer. In: Genitourinary Oncology. 3rd ed. N.J. Vogelzang, P.T. Scarding, W.U. Shipley, D.S. Coffey (eds). Lippincott, Williams and Wilkins; 2005. p. 467—74.
10. Dalbagni G., Genega E., Herr H.W. et al. Cystectomy for bladder cancer: a contemporary series. J Urol 2001;165:1111—6.
11. Mills R.D., Turner W.H., Fleishmann A. et al. Pelvic lymph node metastases: outcome in 83 patients aftr radical cystectomy and pelvic lymphadenectomy. J Urol 2001;166:19—23.
12. Stein J.P., Cai J., Groshen S., Skinner D.G. Risk factors for patients with pelvic lymph node metastases following radical cystectomy with en bloc pelvic lymphadenectomy: concept of lymph node density. J Urol 2003;170(1):35—41.
13. Sherif A., Rintala E., Mestad O. et al. Neoadjuvant cisplatin-methotrexate chemotherapy for invasive bladder cancer Nordic cystectomy trial 2. Scand J Urol Nephrol 2002; 36(6):419—25.
14. International collaboration of Trialists. Neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: a randomized controlled trial. Lancet 1999;354(9178):533—40.
15. Leissner J., Ghoneim M.A., Abol-Enein H. et al. Extended radical lymphadenectomy in patients with urothelial bladder cancer:results of a prospective multicenter study. J Urol 2004;171:139—44.
16. Poulsen J., Krarup T. Pelvic lymphadenectomy (staging) in patients with bladder cancer: laparoscopic versus open approuch. Scand J Urol Nephrol Suppl 1995;172:19—21.
17. Wiesner C., Pfitzenmaier J., Faldum A. et al. Lymph node metastases in non-muscle invasive bladder cancer are correlated with the number of transurethral resections and tumour upstaging at radical cystectomy. BJU Int 2005;95(3):301—5.
18. Vieveg J., Gschwend J.E., Herr H.W. Pelvic lymph node dissection can be curative in patients with node positive bladder cancer. J Urol 1999;161:449—54.
19. Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. Lancet 2003;361:1927—34.
20. Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Adjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis of individual patient data Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Eur Urol 2005;48(2):189-99; discussion 199-201. Epub 2005 Apr 25.
21. Kassouf W., Leibovici D., Munsell M.F. et al. Evaluation of the relevance of lymph node density in a contemporary series of patients undergoing radical cystectomy. J Urol 2006;176(1):53—7.
22. Stockle M., Meyenburg W., Wellek S. et al. Adjuvant polychemotherapy of nonorgan-confined bladder cancer after radical cystectomy revisited: long-term results of a controlled prospective study and further clinical experience. J Urol 1995;153(1):47—52.
23. Simms M.S., Mann G., Kockelbergh R.C., Mellon J.K. The management of lymph node metastasis from bladder cancer. Eur J Surg Oncol 2005;31(4):348—56.
Review
For citations:
Khabalov R.V., Matveev V.B., Volkova M.I., Nosov D.A. Treatment and prognosis in patients with transitional cell carcinoma of the urinary bladder metastasizing to regional lymph nodes. Cancer Urology. 2007;3(4):30-35. (In Russ.) https://doi.org/10.17650/1726-9776-2007-3-4-30-35
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