Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press113510.17650/1726-9776-2007-3-4-30-35DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. URINARY BLADDER CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак мочевого пузыряTreatment and prognosis in patients with transitional cell carcinoma of the urinary bladder metastasizing to regional lymph nodesЛечение и прогноз больных переходноклеточным раком мочевого пузыря с метастазами в регионарные лимфоузлыKhabalovR. V.ХабаловР. В.
Russian Federation

Department of Urology

Moscow

Отделение урологии

Москва

MatveevV. B.МатвеевВ. Б.
Russian Federation

Department of Urology

Moscow

Отделение урологии

Москва

VolkovaM. I.ВолковаМ. И.
Russian Federation

Department of Urology

Moscow

Отделение урологии

Москва

NosovD. A.НосовД. А.
Russian Federation

Department of Urology

Moscow

Отделение урологии

Москва

N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical SciencesРОНЦ им. Н.Н. Блохина РАМН301220073430351602202016022020https://oncourology.abvpress.ru/oncur/article/view/1135

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.

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