ArticleWorld journal of urology2026
Effectiveness of preoperative chemotherapy and radical cystectomy in clinically node-positive and node-negative bladder cancer patients.
Article in World journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposePreoperative chemotherapy (POC) combined with radical cystectomy (RC) is the standard treatment for clinically node-negative (cN0) bladder cancer (BC), but its role in clinically node-positive (cN+) disease remains uncertain. We investigated whether POC + RC improves outcomes in cN+ patients by assessing whether the survival gap between cN0 and cN+ patients is smaller than that historically observed in RC-only cohorts. We also evaluated whether radiographic nodal response predicts prognosis. MATERIALS AND
methodsWe retrospectively analyzed patients with T2-4N0M0 or T1-4N + M0 BC who underwent POC + RC at our institution between 1999 and 2019. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were compared between the cN0 and cN+ groups using Cox regression analysis. The hazard ratios (HRs) for cN+/cN0 survival in our cohort were then compared to published HRs from the largest RC-only series, adjusted for clinical rather than pathological nodal staging (non-inferiority margins: HR 2.19 for RFS, HR 2.39 for CSS).
resultsAmong 142 patients (73 cN0, 69 cN+), 5-year RFS was 68% in both groups. The HR for recurrence in cN+ versus cN0 patients was 1.10 (95% Confidence interval [CI] 0.67–1.80), significantly lower than the RC-only benchmark (HR 2.19), demonstrating non-inferiority and suggesting the benefit of POC in cN+ disease. For CSS, 5-year rates were 80% (cN0) and 70% (cN+); the HR was 1.64 (95% CI 0.92–2.92), not significantly lower than the RC-only margin (HR 2.39). Among 72 cN+ patients with radiographic nodal assessment, complete or stable nodal response predicted superior RFS and CSS (p < 0.001 for both). Pathological downstaging (p = 0.03) and mean lymph node density (p = 0.043) were also significantly better in clinical responders.
conclusionCompared with RC alone, POC + RC narrows the survival gap between cN+ and cN0 patients, supporting its use in cN+ disease. Radiographic nodal response is a robust preoperative predictor of survival and may inform treatment decisions.
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