Abstract
Purpose
To identify pre-surgical imaging predictive value and factors associated with the clinicopathologic discrepancy for implication of definitive pelvic radiotherapy in clinically node-negative bladder cancer.
Method
The documented data of bladder cancer patients who underwent radical cystectomy plus pelvic lymphadenectomy were collected retrospectively. Patients’ characteristics, last imaging, pathology reports, disease-specific survival and overall survival were retrieved.
Results
From 142 patients, pre-surgical imaging had a sensitivity of 76.4%, specificity of 73.7%, positive predictive value (PPV) of 94.9%, and negative predictive value (NPV) of 32.6% (p value < 0.0001) for detection of muscle invasion. Also, for detection of positive lymph nodes, imaging had a sensitivity of 31.8%, specificity of 85.7%, PPV of 50%, and NPV of 73.7% (p value: 0.022). 44.4% of study population were upstaged after surgery (24.6% associated with N-upstaging) and 18.3% were downstaged (12% associated with N-downstaging). Receipt of neoadjuvant chemotherapy and T-stage were not correlated with N-upstaging. On multivariate analysis, lymphovascular invasion (LVI) maintained its significance for independent prediction of upstaging (OR 3.3, 95% CI 1.5–7.5, p value: 0.004) and inversely with downstaging (OR 0.34, 95% CI 0.12–0.96, p value: 0.04). Older age (OR 1.03, 95% CI 1.0–1.05, p value 0.047), positive margins (OR 2.1, 95% CI 1.2–3.8, p value 0.011), presence of LVI (OR 2.5, 95% CI 1.4–4.7, p value 0.003), perineural invasion (OR 2.0, 95% CI 1.2–3.4, p value 0.013), and lymph node ratio (OR 1.011, 95% CI 1.001–1.021, p value 0.03) were associated with worse survival. Also, N-upstaging independently predicted a worse survival after controlling for surgical pathology stage (OR 2.3, 95% CI 1.2–4.5, p value 0.011).
Conclusions
The optimal target volume in definitive chemoradiotherapy of node-negative bladder cancer patients remains to be established. Since then, customizing the treatment is considered especially for positive LVI in TURBT specimen.
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References
Amin MB, Greene FL, Edge SB et al (2017) The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin 67:93–99. https://doi.org/10.3322/caac.21388
Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th Edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–1474. https://doi.org/10.1245/s10434-010-0985-4
Ficarra V, Dalpiaz O, Alrabi N et al (2005) Correlation between clinical and pathological staging in a series of radical cystectomies for bladder carcinoma. BJU Int 95:786–790. https://doi.org/10.1111/j.1464-410X.2005.05401.x
Fonteyne V, Sargos P (2021) What is the optimal dose, fractionation and volume for bladder radiotherapy? Clin Oncol (r Coll Radiol) 33:e245–e250. https://doi.org/10.1016/j.clon.2021.03.013
Goldsmith B, Baumann BC, He J et al (2014) Occult pelvic lymph node involvement in bladder cancer: implications for definitive radiation. Int J Radiat Oncol Biol Phys 88:603–610. https://doi.org/10.1016/j.ijrobp.2013.11.211
Gray PJ, Lin CC, Jemal A et al (2014) Clinical-pathologic stage discrepancy in bladder cancer patients treated with radical cystectomy: results from the national cancer data base. Int J Radiat Oncol Biol Phys 88:1048–1056. https://doi.org/10.1016/j.ijrobp.2014.01.001
Herr HW (2003) Extent of surgery and pathology evaluation has an impact on bladder cancer outcomes after radical cystectomy. Urology 61:105–108. https://doi.org/10.1016/S0090-4295(02)02116-7
Herr H, Lee C, Chang S et al (2004) Standardization of radical cystectomy and pelvic lymph node dissection for bladder cancer: a collaborative group report. J Urol 171:1823–1828. https://doi.org/10.1097/01.ju.0000120289.78049.0e (discussion 1827–8)
Huddart RA, Hall E, Hussain SA et al (2013) Randomized noninferiority trial of reduced high-dose volume versus standard volume radiation therapy for muscle-invasive bladder cancer: results of the BC2001 trial (CRUK/01/004). Int J Radiat Oncol Biol Phys 87:261–269. https://doi.org/10.1016/j.ijrobp.2013.06.2044
Jiang DM, Chung P, Kulkarni GS, Sridhar SS (2020) Trimodality therapy for muscle-invasive bladder cancer: recent advances and unanswered questions. Curr Oncol Rep 22:14. https://doi.org/10.1007/s11912-020-0880-5
Lewis S, Murthy V, Mahantshetty U, Shrivastava SK (2017) Incidental dose to pelvic nodes in bladder-only radiotherapy: Is it clinically relevant? Technol Cancer Res Treat 16:382–387. https://doi.org/10.1177/1533034617691409
Mirmomen SM, Shinagare AB, Williams KE et al (2019) Preoperative imaging for locoregional staging of bladder cancer. Abdom Radiol 44:3843–3857. https://doi.org/10.1007/s00261-019-02168-z
Resnick MJ, Bergey M, Magerfleisch L et al (2011) Longitudinal evaluation of the concordance and prognostic value of lymphovascular invasion in transurethral resection and radical cystectomy specimens. BJU Int 107:46–52. https://doi.org/10.1111/j.1464-410X.2010.09635.x
Stein JP, Lieskovsky G, Cote R et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 19:666–675. https://doi.org/10.1200/JCO.2001.19.3.666
Sung H, Ferlay J, Siegel RL et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71:209–249. https://doi.org/10.3322/caac.21660
Tan MP, Harris V, Warren-Oseni K et al (2020) The intensity-modulated pelvic node and bladder radiotherapy (IMPART) trial: a phase II single-centre prospective study. Clin Oncol (r Coll Radiol) 32:93–100. https://doi.org/10.1016/j.clon.2019.07.017
Tunio MA, Hashmi A, Qayyum A et al (2012) Whole-pelvis or bladder-only chemoradiation for lymph node-negative invasive bladder cancer: single-institution experience. Int J Radiat Oncol Biol Phys 82:e457–e462. https://doi.org/10.1016/j.ijrobp.2011.05.051
Turker P, Bostrom PJ, Wroclawski ML et al (2012) Upstaging of urothelial cancer at the time of radical cystectomy: factors associated with upstaging and its effect on outcome. BJU Int 110:804–811. https://doi.org/10.1111/j.1464-410X.2012.10939.x
Yoneda K, Kamiya N, Utsumi T et al (2021) Impact of lymphovascular invasion on prognosis in the patients with bladder cancer-comparison of transurethral resection and radical cystectomy. Diagnostics (basel). https://doi.org/10.3390/diagnostics11020244
Acknowledgements
We would like to thank Professor Mohamadreza Norouzi, Vice Chair of Department of Urology.
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AS: protocol/project development, data collection and management, manuscript writing/editing; AMS: protocol/project development, manuscript writing/editing; AA: data collection and management; KK: data analysis, manuscript writing/editing; FT: data collection and management; EE: protocol/project development, manuscript writing/editing all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Saeedian, A., Safaei, A.M., Azimi, A. et al. Implications for pelvic lymph node irradiation in definitive chemoradiotherapy of node negative muscle invasive bladder cancer based on predictive factors of clinicopathologic discrepancy. J Cancer Res Clin Oncol 149, 2537–2542 (2023). https://doi.org/10.1007/s00432-022-04153-4
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DOI: https://doi.org/10.1007/s00432-022-04153-4