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The Impact of Adjuvant Chemotherapy on Patients with Lymph Node Metastasis After Radical Cystectomy
Thomas J Guzzo, Arturo Balandra, Alexander Kutikov, Daniel J. Canter, Zhen Chen*, Daniel J. Canter*, S. Bruce Malkowicz
University of Pennsylvania, Philadelphia, PA
Introduction: Radical cystectomy (RC) and urinary diversion remains the gold standard treatment for patients with muscle invasive bladder cancer. Unfortunately, up to 25% of patients will have metastatic lymph node involvement at the time of RC portending a poor prognosis. Adjuvant chemotherapy (AC) in this setting potentially could optimize prognosis with regard to overall (OS) and recurrence free survival (RFS).
Methods: We retrospectively reviewed our RC database from 1988-2003 for patients with lymph node positive disease at the time of RC. OS and RFS were calculated for those patients who received AC compared to those who did not. Multivariable analysis was performed to identify predictors of poor outcome in patients who received AC.
Results: Of the 346 patients in our database, we identified 85 with metastatic lymph node involvement. 55(65%) of the 85 node positive patients received AC. Mean follow-up was 38.3 months in the chemotherapy group and 51.2 months in the non-chemotherapy group. The average number of nodes sampled was 17. OS was significantly better in node positive patients who received AC (p=0.006). On multivariable analysis, a lymph node density of <20% predicted for a favorable response to AC (HR=0.41, 95% CI: 0.2-.82, p=0.012).
Conclusions: AC administered to patients with known lymph node metastasis conferred a significant survival advantage compared to observation in our cohort. Furthermore, a lymph node density of <20% was predictive of a favorable response to AC. Further studies in larger populations are warranted to reveal the exact impact of AC in this subset of patients.
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