Impact of adjuvant chemotherapy on patients with lymph node metastasis at the time of radical cystectomy

Introduction: Radical cystectomy (RC) remains the gold standard treatment for patients with muscle-invasive bladder cancer. Unfortunately, a significant proportion of patients will have lymph node involvement at the time of RC. We set out to determine the impact of adjuvant cisplatin-based chemotherapy (AC) in a cohort of lymph node positive patients following RC. Patients and methods: We reviewed our RC database and isolated patients with lymph node positive disease at the time of RC. Univariate and multivariable analysis was performed to identify predictors of poor outcome in patients receiving AC. Overall survival (OS), disease specific survival (DSS) and recurrence free survival (RFS) were calculated for those patients who received AC compared to those who did not. Results: Of the 316 patients, we identified 85 patients with metastatic lymph node involvement at the time of RC. Fifty-five (65%) of these patients received AC. Median follow up was 46 months. On multivariable analysis lymph node positive patients receiving AC had significantly improved OS, DSS and RFS compared to patients who did not receive AC (p = 0.031, p = 0.028, p = 0.004). The delivery of AC conferred the greatest recurrence-free, disease-specific, and overall survival advantages to those with lymph node densities (LND) of < 20% with (p = 0.016, p = 0.011, p = 0.007, respectively). Conclusion: AC administered to patients with known lymph node metastasis conferred a significant survival advantage compared to observation. Furthermore, a LND of < 20% predicts of a more favorable response to AC. Further studies in larger patient populations are warranted to reveal the exact impact of AC in this subset of patients.