Lack of Effectiveness of Postchemotherapy Lymphadenectomy in Bladder Cancer Patients with Clinical Evidence of Metastatic Pelvic or Retroperitoneal Lymph Nodes Only

Autor: Necchi, Andrea, Mariani, Luigi, Lo Vullo, Salvatore, Yu, Evan, Woods, Michael, Wong, Yu-Ning, Harshman, Lauren, Alva, Ajjaj, Sternberg, Cora, Bamias, Aristotelis, Grivas, Petros, Koshkin, Vadim, Roghmann, Florian, Dobruch, Jakub, Eigl, Bernie, Nappi, Lucia, Milowsky, Matthew, Niegisch, Guenter, Pal, Sumanta, De Giorgi, Ugo, Recine, Federica, Vaishampayan, Ulka, Berthold, Dominik, Bowles, Daniel, Baniel, Jack, Théodore, Christine, Ladoire, Sylvain, Srinivas, Sandy, Agarwal, Neeraj, Crabb, Simon, Sridhar, Srikala, Golshayan, Ali-Reza, Ohlmann, Carsten, Xylinas, Evanguelos, Powles, Thomas, Rosenberg, Johnathan, Bellmunt, Joaquim, van Rhijn, Bas, Galsky, Matthew, Hendricksen, Kees
Přispěvatelé: Fondazione IRCCS Istituto Nazionale dei Tumori, University of Washington [Seattle], University of North Carolina [Chapel Hill] (UNC), University of North Carolina System (UNC), Lineberger Comprehensive Cancer Center (UNC Lineberger), University of North Carolina System (UNC)-University of North Carolina System (UNC), Fox Chase Cancer Center [Philadelphia], Dana-Farber Cancer Institute [Boston], University of Michigan [Ann Arbor], University of Michigan System, San Camillo Forlanini Hospital [Rome], University of Athens Medical School [Athens], Cleveland Clinic, Ruhr University Bochum (RUB), Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf], City of Hope Comprehensive Cancer Center [Duarte], Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Karmanos Cancer Institute, Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Rabin Medical Center - Beilinson and Hasharon Hospitals [Petach-Tikva, Israel], Service d'Oncologie Médicale, Service d'Oncologie Médicale, Hôpital Foch, Suresnes, Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Stanford School of Medicine [Stanford], Stanford Medicine, Stanford University-Stanford University, University of Utah School of Medicine [Salt Lake City], University of Southampton, University of Toronto, Princess Margaret Hospital, Medical University of South Carolina [Charleston] (MUSC), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Barts & The London School of Medicine, IMIM-Hospital del Mar, Generalitat de Catalunya, Division of Surgical Oncology (Urology), Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai [New York] (MSSM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Zdroj: European Urology Focus
European Urology Focus, Elsevier, In press, ⟨10.1016/j.euf.2017.05.006⟩
ISSN: 2405-4569
DOI: 10.1016/j.euf.2017.05.006⟩
Popis: International audience; BackgroundLimited data is available on the role, and extent of, postchemotherapy lymphadenectomy (PC-LND) in patients with clinical evidence of pelvic (cN1–3) or retroperitoneal (RP) lymph node spread from urothelial bladder carcinoma.ObjectiveTo compare the outcomes of operated versus nonoperated patients after first-line chemotherapy.Design, setting, and participantsData from 34 centers was collected, totaling 522 patients, treated between January 2000 and June 2015. Criteria for patient selection were the following: bladder primary tumor, lymph node metastases (pelvic ± RP) only, first-line platinum-based chemotherapy given.InterventionLND (with cystectomy) versus observation after first-line chemotherapy for metastatic urothelial bladder carcinoma.Outcome measures and statistical analysisOverall survival (OS) was the primary endpoint. Multiple propensity score techniques were adopted, including 1:1 propensity score matching and inverse probability of treatment weighting. Additionally, the inverse probability of treatment weighting analysis was performed with the inclusion of the covariates, that is, with doubly robust estimation.Results and limitationsOverall, 242 (46.4%) patients received PC-LND and 280 (53.6%) observation after chemotherapy. There were 177 (33.9%) and 345 (66.1%) patients with either RP or pelvic LND only, respectively. Doubly robust estimation-adjusted comparison was not significant for improved OS for PC-LND (hazard ratio [HR]: 0.86, 95% confidence interval [CI]: 0.56–1.31, p = 0.479), confirmed by matched analysis (HR: 0.91, 95% CI: 0.60–1.36, p = 0.628). This was also observed in the RP subgroup (HR: 1.12, 95% CI: 0.68–1.84). The retrospective nature of the data and the heterogeneous patient population were the major limitations.ConclusionsAlthough there were substantial differences between the two groups, after accounting for major confounders we report a nonsignificant OS difference with PC-LND compared with observation only. These findings may be hypothesis-generating for future prospective trials.Patient summaryWe found no differences in survival by adding postchemotherapy lymphadenectomy in patients with pelvic or retroperitoneal lymph node metastatic bladder cancer. The indication to perform postchemotherapy lymphadenectomy in the most suitable patients requires additional studies.
Databáze: OpenAIRE
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