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Natural history of pT3-4 or node positive bladder cancer treated with radical cystectomy and no neoadjuvant chemotherapy in a contemporary North-American multi-institutional cohort.
MedLine Citation:
PMID:  23283097     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The present study documents the natural history and outcomes of high-risk bladder cancer after radical cystectomy (RC) in patients who did not receive neoadjuvant chemotherapy during a contemporary time period.
METHODS: We analyzed 1180 patients from 1993 to 2008 with >pT3N0 or pT0-4N+ bladder cancer who underwent RC ± standard (sLND) or extended (eLND) lymph node dissection from 8 Canadian centres.
RESULTS: Of the 1180 patients, 55% (n = 643) underwent sLND, 34% (n = 402) underwent ePLND and 11% did not undergo a formal LND. Of the total number of patients, 321 (27%) received adjuvant chemotherapy. The median follow-up was 2.1 years (range: 0.6 to 12.9). Overall 30-day mortality was 3.2%. Clinical and pathological stages T3-4 were present in 6.1% and 86.7% of the patients, respectively; this demonstrates a dramatic understaging. Overall survival (OS) at 2 and 5 years was 60% and 43%, respectively. Patients who received adjuvant chemotherapy had a 2- and 5-year disease-specific survival (DSS) of 72% and 57% versus 64% and 51% for those who did not (log-rank p = 0.0039). The 2- and 5-year OS for high-risk node-negative disease was 67% and 52%, respectively, whereas for node-positive patients, the OS was 52% and 32%, respectively (p < 0.001). The OS, DSS and RFS for patients with pN0 were significantly improved compared to those who did not undergo a LND (log-rank p = 0.0035, 0.0241 and 0.0383, respectively).
INTERPRETATION: This series suggests that bladder cancer outcomes in advanced disease have improved in the modern era. The need for improved staging investigations, use of neoadjuvant chemotherapy and performance of complete LND is emphasized.
Authors:
Nicholas E Power; Wassim Kassouf; David Bell; Armen G Aprikian; Yves Fradet; Louis Lacombe; Joseph Chin; Jonathan Izawa; Eric Estey; Adrian Fairey; Ilias Cagiannos; Jean-Baptiste Lattouf; Darrel Drachenberg; Ricardo A Rendon
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Canadian Urological Association journal = Journal de l'Association des urologues du Canada     Volume:  6     ISSN:  1911-6470     ISO Abbreviation:  Can Urol Assoc J     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2013-01-03     Completed Date:  2013-01-04     Revised Date:  2013-04-18    
Medline Journal Info:
Nlm Unique ID:  101312644     Medline TA:  Can Urol Assoc J     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  E217-23     Citation Subset:  -    
Affiliation:
Dalhousie University, Halifax, NS.
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