# Neoadjuvant Gemcitabine-Cisplatin Plus Radical Cystectomy-Pelvic Lymph Node Dissection for Muscle-invasive Bladder Cancer: A 12-year Experience.

**Tumor:** Cáncer de vejiga músculo-invasivo
**Autores:** Iyer G, Tully CM, Zabor EC et al
**Revista:** Clin Genitourin Cancer (2020)
**PMID:** 32273235 | **PMCID:** PMC8375301
**DOI:** [10.1016/j.clgc.2020.02.014](https://doi.org/10.1016/j.clgc.2020.02.014)
**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
The aim of this study was to determine drug delivery/toxicity, and pathologic/surgical outcomes of patients with muscle-invasive bladder cancer (MIBC) receiving neoadjuvant gemcitabine-cisplatin (GC) plus radical cystectomy-pelvic lymph node dissection (RC-PLND).

Chemotherapy and surgical/pathologic outcomes were retrospectively analyzed with 5-year survival follow-up at a referral center. Post-neoadjuvant chemotherapy (NAC) pathologic endpoints included complete response (pT0N0), residual non-MIBC (pTa/Tis/T1N0), and&#xa0;&#x2265; MIBC (&#x2265; pT2 and/or N+). Associations of pathologic/surgical findings with overall survival (OS), disease-free survival (DFS), and surgical management with RC-PLND were analyzed (Cox regression).

Clinical T2a-T4aN0M0 MIBC patients (n&#xa0;= 154) from January 2000-October 2012 received GC plus RC-PLND. Patients (n&#xa0;= 117; 76%) received GC&#xa0;&#xd7; 4 and 136 (88%) GC&#xa0;&#xd7; 3. Five-year OS was 61% (95% confidence interval [CI], 53-71). Median number of resected lymph nodes (LNs) was 19. Down-staging was observed as follows: pT0N0: 21%; pTa/Tis/T1N0: 25%, with similar 5-year OS (85% and 89%, respectively). Five-year OS for&#xa0;< pT2 versus&#xa0;&#x2265; pT2 residual disease was 87% (95% CI, 78%-98%) versus 38% (95% CI, 27%-53%); P&#xa0;< .001. Post-NAC stage&#xa0;&#x2265; pT2 (HR, 6.79; 95% CI, 2.63-17.53; P&#xa0;< .001), positive LN (HR, 3.64; 95% CI, 1.84-7.19; P&#xa0;< .001), and positive margins (HR, 4.15; 95% CI, 1.68-10.25; P&#xa0;= .002) were associated with increased risk of all-cause death (multivariable analysis). An HR of 0.97 (95% CI, 0.94-1.00) was observed for each additional node removed, but this effect was not statistically significant (P&#xa0;= .056).

Neoadjuvant GC achieves meaningful pathologic responses. Patients with&#xa0;&#x2265; pT2 residual disease, positive margins, or positive LN post-chemotherapy have inferior survival.

## Acceso
Disponible en PMC: https://pmc.ncbi.nlm.nih.gov/articles/PMC8375301/

---
*Datos de PubMed. Citar: doi 10.1016/j.clgc.2020.02.014*
