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| |  Lymph Node Stage and Adjuvant Chemotherapy Are Prognostic Factors for Survival in Patients With Advanced Bladder Cancer: Presented at EMUC By Chris Berrie BARCELONA, Spain -- December 1, 2009 -- Lymph node stage and adjuvant chemotherapy are strong prognostic factors for survival in patients with bladder cancer with T4 disease undergoing radical cystectomy, according to research presented at the 2nd European Multidisciplinary Meeting on Urological Cancers (EMUC). In the current literature, “there are insufficient data about pT4 bladder cancer patients undergoing radical cystectomy,” noted principal investigator Thomas Hofner, MD, University of Heidelberg, Heidelberg, Germany, speaking here on November 29. The objective of Dr. Hofner’s study was to determine prognostic factors for cancer-specific survival (CSS) in these patients, including the role of lymphadenectomy and adjuvant chemotherapy. He provided an initial summary of the current data from his retrospective multicentre study for pT4 bladder cancer. The database of over 2,200 patients with bladder cancer undergoing radical cystectomy included 252 patients with T4 disease. The patients with T4 disease were divided equally between pT4a and pT4b (54% vs 46%) and pN0 and pN+ (49% vs 51%), with a median of 3 positive lymph nodes and a median of 12 lymph nodes removed. “Only 34% of all patients had had adjuvant chemotherapy,” Dr. Hofner added. At a median follow-up of 20.3 months, there were 162 (64%) cancer-specific deaths recorded, with median 1-year and 5-year CSS rates of 64% and 16%, respectively. For CSS, a significant difference was seen across the level of lymphatic metastatic disease, with graded improved survival probabilities from pT4pN2 through pT4pN1 to pT4pN0 (P = .001). Similarly, significant survival benefit was seen for adjuvant chemotherapy, looking at all T4 patients (P = .05), particularly those with lymphatic metastasised disease (T4N+) (P = .004). There was no significance seen across the different lymph node densities, divided according to either the 20% or 50% levels, despite this being a prognostic factor for muscle-invasive bladder cancer stages. Multivariate analysis also confirmed the significance of both nodal status (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.09-2.13; P = .015) and adjuvant chemotherapy (HR, 0.54; 95% CI, 0.31-0.94; P = .031). Dr. Hofner noted the limitations of a retrospectively designed trial, with no central pathological review, no knowledge of extent of lymphadenectomy, and different chemotherapeutic agents used. He stressed, however, that “without a prospective trial in T4 bladder cancer, our study is the first that contains detailed information about the outcome of the most advanced bladder cancer after radical cystectomy.” EMUC was co-organised by the European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), and the European Society for Therapeutic Radiology and Oncology (ESTRO). [Presentation title: Advanced T4 Stage Bladder Cancer: Patients Benefit From Interdisciplinary Approach of Radical Surgery and Adjuvant Chemotherapy. Oral Abstract O4]
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