# Occult lymph node metastases in patients without residual muscle-invasive bladder cancer at radical cystectomy with or without neoadjuvant chemotherapy: a nationwide study of 5417 patients.

**Tumor:** Cáncer de vejiga músculo-invasivo
**Autores:** van Hoogstraten LMC, van Gennep EJ, Kiemeney LALM et al
**Revista:** World J Urol (2021)
**PMID:** 34585294 | **PMCID:** PMC8813846
**DOI:** [10.1007/s00345-021-03839-7](https://doi.org/10.1007/s00345-021-03839-7)
**Fuente:** PubMed Central (open access)

## Relevancia
Cáncer de vejiga músculo-invasivo (cN+/cN0) tras quimioterapia neoadyuvante basada en cisplatino o inmunoterapia (KEYNOTE-866, EV-302): tasas de ypN0, calidad de PLND y pronóstico. Similar al paradigma mamario: la respuesta ganglionar patológica es un marcador pronóstico clave y la PLND completa sigue siendo esencial incluso con downstaging.

## Abstract
Little is known about the prevalence of occult lymph node metastases (LNM) in muscle-invasive bladder cancer (MIBC) patients with pathological downstaging of the primary tumor. We aimed to estimate the prevalence of occult LNM in patients without residual MIBC at radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC) or neoadjuvant radiotherapy (NAR), and to assess overall survival (OS).

Patients with cT2-T4aN0M0 urothelial MIBC who underwent RC plus pelvic lymph node dissection (PLND) with curative intent between January 1995-December 2013 (retrospective Netherlands Cancer Registry (NCR) cohort) and November 2017-October 2019 (prospective NCR-BlaZIB cohort (acronym in Dutch: BlaaskankerZorg In Beeld; in English: Insight into bladder cancer care)) were identified from the nationwide NCR. The prevalence of occult LNM was calculated and OS of patients with&#x2009;<(y)pT2N0 vs.&#x2009;<(y)pT2N+&#x2009;disease was estimated by the Kaplan-Meier method.

In total, 4657 patients from the NCR cohort and 760 patients from the NCR-BlaZIB cohort were included. Of 1374 patients downstaged to &#x2009;<(y)pT2, 4.3% (N&#x2009;=&#x2009;59) had occult LNM 4.1% (N&#x2009;=&#x2009;49) of patients with cT2-disease and 5.6% (N&#x2009;=&#x2009;10) with cT3-4a-disease. This was 4.0% (N&#x2009;=&#x2009;44) in patients without NAC or NAR, 4.5% (N&#x2009;=&#x2009;10) in patients with NAC, and 13.5% (N&#x2009;=&#x2009;5) in patients with NAR but number of patients treated with NAR and downstaged disease was small. The prevalence of &#x2009;<(y)pT2N+&#x2009;disease was 4.2% (N&#x2009;=&#x2009;48) in the NCR cohort and 4.6% (N&#x2009;=&#x2009;11) in the NCR-BlaZIB cohort. For patients with &#x2009;<(y)pT2N+&#x2009;and &#x2009;<(y)pT2N0, median OS was 3.5&#xa0;years (95% CI 2.5-8.9) versus 12.9&#xa0;years (95% CI 11.7-14.0), respectively.

Occult LNM were found in 4.3% of patients with cT2-4aN0M0 MIBC with (near-) complete downstaging of the primary tumor following RC plus PLND. This was regardless of NAC or clinical T-stage. Patients with occult LNM showed considerable worse survival. These results can help in counseling patients for bladder-sparing treatments.

## Acceso
Disponible en PMC: https://pmc.ncbi.nlm.nih.gov/articles/PMC8813846/

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*Datos de PubMed. Citar: doi 10.1007/s00345-021-03839-7*
