The following is a summary of “Role of Radical Cystectomy in Clinically Node Positive Bladder Cancer: A US Veterans Health Administration Study,” published in the February 2024 issue of Oncology by Meagher et al.

The optimal approach for managing clinically positive regional lymph node (cN+) bladder cancer remains uncertain, particularly regarding the role of radical cystectomy (RC) in addition to systemic treatment. This study aimed to explore the impact of RC on the management of patients with cN+ bladder cancer within US Veterans Health Administration Facilities. Using data from the Department of Veterans Affairs (VA) Informatics and Computing Infrastructure (VINCI), the researchers identified patients diagnosed with cN+ bladder cancer between 2000 and 2017. 

Through a combination of database analysis and chart review, the study group collected relevant patient information. To mitigate mortality bias, individuals who died within 90 days of diagnosis were excluded from the analysis. Patients were categorized into cohorts based on whether they underwent RC or received alternative treatment (“no cystectomy” [NOC]). Propensity score matching was conducted to account for factors influencing the decision to undergo RC. Multivariable Cox models and Kaplan-Meier survival curves were utilized to evaluate overall survival (OS) and cancer-specific survival (CSS). After matching, 158 patients were included in the RC and NOC groups. In the RC group, a notable proportion received pre- and post-cystectomy chemotherapy. There was no significant difference in the distribution of clinical N1 disease between the RC and NOC groups. 

The multivariable Cox model revealed that undergoing RC was independently associated with improved OS and CSS. These findings suggest that, as part of a multimodal treatment approach, RC may confer survival benefits for certain patients with cN+ bladder cancer. However, prospective randomized trials are warranted to validate these results and elucidate the optimal management strategy for this specific patient population.

 Source: sciencedirect.com/science/article/abs/pii/S1558767324000284