Patients with bladder cancer with clinical lymph node involvement (cN⁺ ) are at high risk for distant metastases, but are potentially curable. Such patients are excluded fromneoadjuvant chemotherapy trials and pooled with patients with distant metastases in first-line chemotherapy trials not suited to define the role of combined-modality therapy. To analyze a comparative effectiveness for avoiding invalid evidence.

A retrospective study was conducted for 522 patients who underwent chemotherapy and/or cystectomy between January 2003 and January 2013 for cTanyN1-3M0 bladder cancer patients. We used multivariable adjustment for tumor- and patient- characteristics to assess effectiveness.

Among 522 patients (cN1, 47%; cN2, 43%; cN3, 10%), 342 patients underwent cystectomy and 180 patients were treated with chemotherapy alone. Of the cystectomy patients, 116 patients received preoperative and 96 patients received adjuvant chemotherapy. The crude 5-year OS for chemotherapy alone, cystectomy alone, preoperative chemotherapy followed by cystectomy, and cystectomy followed by adjuvant chemotherapy was 12%(95% CI: 9%~14%), 19%(95% CI: 13%~23%), 32%(95% CI: 26%~37%), 25%(95% CI: 20%~32%), respectively. Compared with cystectomy alone, preoperative chemotherapy was associated with a significant improvement in OS (HR 0.68, 95% CI: 0.54~0.92). Adjuvant chemotherapy was also associated with a significant improvement in survival compared with cystectomy alone. The survival in patients were treated with chemotherapy alone was worse than those were treated with cystectomy alone.

The patients with cN⁺ bladder cancer achieves long survival.Combined-modality therapy, with chemotherapy and cystectomy, is associated with the best effect.

Urinary Bladder Neoplasms; Lymph Nodes; Cystectomy