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@article{1597539,
author = {Staník, Michal and Poprach, Alexandr and Zapletalová, Michaela and Krejčí, Denisa and Macik, Daniel and Capak, Ivo and Jarkovský, Jiří and Lakomy, Radek and Dolezel, Jan},
article_location = {DALLAS},
article_number = {4},
doi = {http://dx.doi.org/10.1016/j.clgc.2019.04.007},
keywords = {Chemotherapy; Combined modality therapy; Cystectomy; Lymphadenopathy; Urinary bladder neoplasms},
language = {eng},
issn = {1558-7673},
journal = {CLINICAL GENITOURINARY CANCER},
title = {Comparison of Different Treatment Modalities Outcomes in Clinically Node-positive Bladder Cancer: Analysis of a Population-based Cancer Registry},
url = {http://dx.doi.org/10.1016/j.clgc.2019.04.007},
volume = {17},
year = {2019}
}
TY - JOUR
ID - 1597539
AU - Staník, Michal - Poprach, Alexandr - Zapletalová, Michaela - Krejčí, Denisa - Macik, Daniel - Capak, Ivo - Jarkovský, Jiří - Lakomy, Radek - Dolezel, Jan
PY - 2019
TI - Comparison of Different Treatment Modalities Outcomes in Clinically Node-positive Bladder Cancer: Analysis of a Population-based Cancer Registry
JF - CLINICAL GENITOURINARY CANCER
VL - 17
IS - 4
SP - "E759"-"E767"
EP - "E759"-"E767"
PB - CIG MEDIA GROUP, LP
SN - 15587673
KW - Chemotherapy
KW - Combined modality therapy
KW - Cystectomy
KW - Lymphadenopathy
KW - Urinary bladder neoplasms
UR - http://dx.doi.org/10.1016/j.clgc.2019.04.007
L2 - http://dx.doi.org/10.1016/j.clgc.2019.04.007
N2 - Recently, a few retrospective studies demonstrated a potential benefit of multimodal therapy in patients with clinically node-positive bladder cancer. We assessed the efficacy of different treatment modalities in 661 patients (cTanyN1-3M0) identified from the Czech National Cancer Registry. When compared with chemotherapy, combined treatment integrating cystectomy and perioperative chemotherapy reduced the risk of overall mortality by 21% and may lead to a long-term survival in one-quarter of patients. Introduction: Patients with clinically node-positive bladder cancer were historically considered to have uniformly poor prognosis and were frequently treated with palliative chemotherapy (CHT) only. Although retrospective data show that long-term survival with combined treatment (surgery + CHT) is possible in one-third of these patients, consensus on a treatment algorithm is still lacking. The aim of the study is to compare the efficacy of different treatment modalities based on data from a population-based cancer registry. Patients and Methods: The study comprises 661 patients identified from the Czech National Cancer Registry (1996-2015) with cTanyN1-3M0 bladder cancer; 195 were treated with CHT alone, 234 underwent radical cystectomy alone (RC), and 232 received a combination of RC and perioperative CHT (RC + CHT). Multivariate Cox proportional hazard regression analyses were used to evaluate the effectiveness of various treatments. Results: The 5-year OS for CHT alone, RC alone, and RC + CHT were 21.7% (95% confidence interval [CI], 15.4%-28.0%), 12.1% (95% CI, 7.4%-16.7%), and 25.4% (95% CI, 18.9%-31.9%), respectively (P < .001). The median survivals were 17, 10, and 23 months, respectively. In multivariate analysis, age > 60 years (hazard ratio, 1.29; 95% CI, 1.06-1.56; P = .011) and clinical stage cT3-4 (hazard ratio, 1.39; 95% CI, 1.12-1.71; P = .002) were negative predictors of survival. When compared with CHT, RC + CHT reduced the risk of overall mortality by 21% (P = .044). Conclusion: Approximately one-quarter of clinically node-positive patients may achieve long-term survival with combined treatment integrating RC and perioperative CHT. The overall survival of patients is significantly improved with a multimodal approach in comparison to CHT alone. (C) 2019 Elsevier Inc. All rights reserved.
ER -
STANÍK, Michal, Alexandr POPRACH, Michaela ZAPLETALOVÁ, Denisa KREJČÍ, Daniel MACIK, Ivo CAPAK, Jiří JARKOVSKÝ, Radek LAKOMY and Jan DOLEZEL. Comparison of Different Treatment Modalities Outcomes in Clinically Node-positive Bladder Cancer: Analysis of a Population-based Cancer Registry. \textit{CLINICAL GENITOURINARY CANCER}. DALLAS: CIG MEDIA GROUP, LP, 2019, vol.~17, No~4, p.~''E759''-''E767'', 9 pp. ISSN~1558-7673. Available from: https://dx.doi.org/10.1016/j.clgc.2019.04.007.
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