Introduction

Survival expectancies is poor for bladder cancer (BCa) patients with disseminated disease. On the other hand, several reports showed that patients with survival in node positive patients treated with radical cystectomy (RC) is not invariably poor. However, at the time only scarce data exists about the efficacy of surgery in clinical node positive BCa patients with a limited disseminated disease.

Methods

We evaluated a total of 192 patients with BCa and concurrent node positive disease in the pelvis. All patients were treated with RC and pelvic lymph node dissection (PLND) without neoadjuvant chemotherapy between 2001 and 2013. Adjuvant chemotherapy was offered to patients on the bases of their characteristics and physicians preferences. We analyzed concordance between clinical and pathological findings. Moreover, Kaplan Meier analyses and Cox regression analyses were used to assess the impact of this features on recurrence, cancer specific survival (CSS) and overall survival (OS) after surgery.

Results

With a median follow up of 48 months, we recorded 5 year recurrence, CSS and OS of 46%, 44% and 38%, respectively. Overall, 99 patients (51.6%) where found without node metastases at RC, while 18 (9.4%), 58 (30.2%) and 17 (8.9%) patients were found pN1, pN2 and pN3, respectively. 5 year CSS survival rates were 54%, 42%, 32% and 18% for pN0, pN1, pN2 and pN3, respectively. Overall, 36 (18.8%) patients were treated with adjuvant chemotherapy. At univariable Cox regression analyses, the use of adjuvant chemotherapy was not associated with improved recurrence, CSS and OS after RC (all p>0.2). On the other hand, when only pN+ patients were considered,_x000D_ adjuvant chemotherapy was associated with improved OS (Hazard ratio [HR]: 0.42, confidence interval [CI]: 0.20-0.86, p=0.02).

Conclusions

We report excellent survival outcomes in clinical node positive patients treated with RC. The use of adjuvant chemotherapy_x000D_ after surgery was not associated with improvement in survival expectancies in cN+ patients, on the other hand, when only pN+ patients were considered adjuvant chemotherapy showed increased overall survival expectations. Our data needs to be further evaluated in high quality prospective study.

Funding

none