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Necchi A, Mariani L, Lo Vullo S, Yu EY, Woods ME, Wong YN, Harshman LC, Alva A, Sternberg CN, Bamias A, Grivas P, Koshkin VS, Roghmann F, Dobruch J, Eigl BJ, Nappi L, Milowsky MI, Niegisch G, Pal SK, De Giorgi U, Recine F, Vaishampayan U, Berthold DD, Bowles DW, Baniel J, Theodore C, Ladoire S, Srinivas S, Agarwal N, Crabb S, Sridhar S, Golshayan AR, Ohlmann C, Xylinas E, Powles T, Rosenberg JE, Bellmunt J, van Rhijn B, Galsky MD, Hendricksen K. Lack of Effectiveness of Postchemotherapy Lymphadenectomy in Bladder Cancer Patients with Clinical Evidence of Metastatic Pelvic or Retroperitoneal Lymph Nodes Only: A Propensity Score-based Analysis. Eur Urol Focus 2017; 5:242-249. [PMID: 28753897 DOI: 10.1016/j.euf.2017.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 05/04/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Limited 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. OBJECTIVE To compare the outcomes of operated versus nonoperated patients after first-line chemotherapy. DESIGN, SETTING, AND PARTICIPANTS Data 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. INTERVENTION LND (with cystectomy) versus observation after first-line chemotherapy for metastatic urothelial bladder carcinoma. OUTCOME MEASURES AND STATISTICAL ANALYSIS Overall 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 LIMITATIONS Overall, 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. CONCLUSIONS Although 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 SUMMARY We 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.
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Affiliation(s)
- Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | - Luigi Mariani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Evan Y Yu
- University of Washington, Seattle, WA, USA
| | - Michael E Woods
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, NC, USA
| | | | | | - Ajjaj Alva
- University of Michigan, Ann Arbor, MI, USA
| | | | | | - Petros Grivas
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Vadim S Koshkin
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jakub Dobruch
- Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Bernie J Eigl
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Lucia Nappi
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Matthew I Milowsky
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, NC, USA
| | - Guenter Niegisch
- Heinrich-Heine-University, Medical faculty, Department of Urology, Düsseldorf, Germany
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Ugo De Giorgi
- IRCCS Istituto Scientifico Romagnolo per lo studio e la Cura dei Tumori, Meldola, Italy
| | - Federica Recine
- IRCCS Istituto Scientifico Romagnolo per lo studio e la Cura dei Tumori, Meldola, Italy
| | | | | | - Daniel W Bowles
- Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, CO, USA
| | | | | | | | - Sandy Srinivas
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Simon Crabb
- University of Southampton, Southampton, United Kingdom
| | - Srikala Sridhar
- Princess Margaret Hospital, University Health Network, Toronto, Canada
| | | | | | - Evanguelos Xylinas
- Cochin Hospital, Assistance-Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Thomas Powles
- Barts Health and the Royal Free NHS Trust, Queen Mary University of London, London, UK
| | | | | | - Bas van Rhijn
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Matthew D Galsky
- Mount Sinai School of Medicine, Tisch Cancer Institute, New York, NY, USA
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