The Risk Of Persistent Local Disease In Bladder Cancer Patients Found To Be Pathologic Stage T0 At Radical Cystectomy

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 01 Jul 2008 - 2:00 PDT

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ORLANDO, FL (UroToday.com) - Pathologic stage T0 (pT0) rates following radical cystectomy (RC) alone range from 10-15%. The pT0 rate increases in patients that have received neoadjuvant platinum-based chemotherapy. Survival in patients that achieve pT0 status is significantly improved compared to patients with residual invasive disease. Increasingly clinicians are questioning the necessity for RC in patients that can be identified as pT0 in the bladder after chemotherapy.

While post-chemotherapy staging of the bladder is known, the risk of involvement of the pelvic lymph nodes (LNs) in these patients is less well documented. The authors sought to evaluate the status of the regional LNs in patients that have achieved pT0 status. Therefore, the authors evaluated the pathologic characteristics of patients with Tis-T4 disease on transurethral resection of the bladder tumor, but were pT0 at the time of radical cystectomy. They evaluated the LN status at time of radical cystectomy.

Out of 1,925 patients undergoing a RC between 1990 and 2008, 51 had received chemotherapy prior to RC and were pT0 at the time of surgery. The median LN count was 12 (range 1-51). None of the 33 patients receiving neoadjuvant chemotherapy and 33% of the 21 patients who had received chemotherapy prior to cystectomy for metastatic or locally advanced disease had lymph node metastases at the time of surgery.

The authors concluded that the regional LNs in the pT0 population remain a potential site of active disease in patients who received chemotherapy for locally advanced bladder cancer. The risk of LN metastases in patients who receive neoadjuvant chemotherapy for cT3 or less disease and are pT0 at time of surgery is very low.

Presented by Matthew G Kaag, MD, Guido Dalbagni, MD, Matthew Milowsky, MD, and Bernard H Bochner, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor David P. Wood, MD

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