title: Outcomes of radical cystectomy with extended lymphadenectomy alone in patients with lymph node-positive bladder cancer who are unfit for or who decline adjuvant chemotherapy.
abstract: OBJECTIVE
  To analyse the long-term outcomes of patients with lymph node (LN)-positive bladder cancer, who did not receive any adjuvant therapy after radical cystectomy (RC) and extended pelvic lymph node dissection (ePLND).
  
  
  METHODS
  We conducted a retrospective, combined cohort analysis based on two prospectively maintained cystectomy databases from the University of Southern California and the University of Bern. Eligible patients underwent RC with ePLND for cN0M0 disease but were found to have LN-positive disease. No patient had neoadjuvant therapy, and all had negative surgical margins. Kaplan-Meier plots were used to estimate recurrence-free survival (RFS) and overall survival (OS). Subgroup comparisons were performed using log-rank tests, and multivariable analysis was based on Cox proportional hazard models.
  
  
  RESULTS
  Of 521 patients with LN-positive disease, 251 (48%) never received adjuvant therapy. Although the pathological stage distribution was similar, the 251 patients who did not receive adjuvant therapy were older and had both fewer total and positive LNs than those who underwent adjuvant therapy. The median RFS for patients treated with RC alone was 1.6 years. Recurrences mainly occurred <2 years after RC, resulting in 5- and 10-year RFS rates of 32 and 26%, respectively. Pathological T stage, the total number of LNs and the number of positive LNs detected were independent predictors of RFS and OS.
  
  
  CONCLUSIONS
  In this study, 25% of patients with documented LN metastases who did not receive adjuvant therapy were cured with RC and ePLND; however, a few relapses may occur later than 3 years. Predictors of survival were pathological T stage, the number of total LNs and the number of positive LNs identified.
authors.affiliation: USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Zehnder
authors.forename: Urs E
authors.initials: UE
authors.lastname: Studer
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
authors.forename: Frédéric D
authors.initials: FD
authors.lastname: Birkhäuser
authors.forename: Eila C
authors.initials: EC
authors.lastname: Skinner
authors.forename: Beat
authors.initials: B
authors.lastname: Roth
authors.forename: Gus
authors.initials: G
authors.lastname: Miranda
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Burkhard
authors.forename: Jie
authors.initials: J
authors.lastname: Cai
authors.forename: Donald G
authors.initials: DG
authors.lastname: Skinner
authors.forename: George N
authors.initials: GN
authors.lastname: Thalmann
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D016312:Treatment Refusal; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy*
keywords: cystectomy; extended lymphadenectomy; no chemotherapy; outcome