A Predictive Nomogram for Development of Lymph Node Metastasis in Muscle-Invasive Bladder Cancer Following Neoadjuvant Therapy

Garrett K. Harada, MD; Steven N. Seyedin, MD; Olivia Heutlinger, BS; Armon Azizi, BS; Audree Hsu, BS; Arash Rezazadeh, MD; Michael Daneshvar, MD, MS; Greg E. Gin, MD; Edward M. Uchio, MD; Giovanna A. Giannico, MD; Jeremy P. Harris, MD; Aaron B. Simon, MD, PhD; Jeffrey V. Kuo, MD; Nataliya Mar, MD

Advances in Radiation Oncology (Jan 2025)

A Predictive Nomogram for Development of Lymph Node Metastasis in Muscle-Invasive Bladder Cancer Following Neoadjuvant Therapy

Garrett K. Harada, MD,
Steven N. Seyedin, MD,
Olivia Heutlinger, BS,
Armon Azizi, BS,
Audree Hsu, BS,
Arash Rezazadeh, MD,
Michael Daneshvar, MD, MS,
Greg E. Gin, MD,
Edward M. Uchio, MD,
Giovanna A. Giannico, MD,
Jeremy P. Harris, MD,
Aaron B. Simon, MD, PhD,
Jeffrey V. Kuo, MD,
Nataliya Mar, MD

Affiliations

Garrett K. Harada, MD: Department of Radiation Oncology, Chao Family Cancer Center, University of California, Irvine Medical Center, Orange, California
Steven N. Seyedin, MD: Department of Radiation Oncology, Chao Family Cancer Center, University of California, Irvine Medical Center, Orange, California; Corresponding author: Steven N. Seyedin, MD
Olivia Heutlinger, BS: School of Medicine, University of California, Irvine, Irvine, California
Armon Azizi, BS: School of Medicine, University of California, Irvine, Irvine, California
Audree Hsu, BS: California University of Science and Medicine, Colton, California
Arash Rezazadeh, MD: Division of Hematology and Oncology, University of California, Irvine Medical Center, Orange, California
Michael Daneshvar, MD, MS: Department of Urology, University of California, Irvine Medical Center, Orange, California
Greg E. Gin, MD: Department of Urology, University of California, Irvine Medical Center, Orange, California
Edward M. Uchio, MD: Department of Urology, University of California, Irvine Medical Center, Orange, California
Giovanna A. Giannico, MD: Department of Pathology and Laboratory Medicine, University of California, Irvine Medical Center, Orange, California
Jeremy P. Harris, MD: Department of Radiation Oncology, Chao Family Cancer Center, University of California, Irvine Medical Center, Orange, California
Aaron B. Simon, MD, PhD: Department of Radiation Oncology, Chao Family Cancer Center, University of California, Irvine Medical Center, Orange, California
Jeffrey V. Kuo, MD: Department of Radiation Oncology, Chao Family Cancer Center, University of California, Irvine Medical Center, Orange, California
Nataliya Mar, MD: Division of Hematology and Oncology, University of California, Irvine Medical Center, Orange, California

Journal volume & issue: Vol. 10, no. 1
p. 101671

Abstract

Read online

Purpose: Pelvic lymph node metastases (ypN+) after multiagent neoadjuvant chemotherapy (NAC) is a poor prognostic sign in nonmetastatic muscle-invasive bladder cancer (nmMIBC). We sought to create a nomogram predicting probability of ypN+ after NAC for cN0 nmMIBC and determine association with overall survival (OS). Methods and Materials: We reviewed the National Cancer Database for patients with cT2-4N0M0 urothelial carcinoma of the bladder receiving multiagent NAC and surgery from 2004 to 2020. Following a data split, univariate logistic regression identified variables associated with ypN+ at P < .05. Eligible variables were used for multivariate logistic regression and nomogram generation. A threshold for 95% sensitivity defined high- and low-risk groups for ypN+. Fine–Gray models assessed ypN+ risk group and OS, accounting for competing risks of surgical mortality. Results: A total of 6194 patients were identified with a median follow-up of 39.5 months (interquartile range [IQR], 20.5-67.2 months). Most patients had high-grade (97.7%) cT2 disease (70.8%) with nonpapillary urothelial histology (67.3%) and initiated NAC at a median of 41.0 days after diagnosis (IQR, 28.0-59.0 days).The nomogram included age in decades (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.87–1.03; P = .172), weeks from diagnosis to NAC (OR, 1.02; 95% CI, 1.01-1.04; P = .004), nonpapillary histology (OR, 1.17; 95% CI, 0.99-1.39; P = .068), and clinical T-stage. Within the testing cohort, ypN+ was found in 392 (22.8%) high-risk and 12 (8.0%) low-risk patients (P < .001), with median OS of 36.1 and 74.0 months, respectively (P < .001). High-risk patients had worse OS despite competing risks of 30-day (subdistribution hazard ratio [SHR], 1.80; 95% CI, 1.49-2.18; P < .001) and 90-day surgical mortality (SHR, 1.68; 95% CI, 1.39-2.04; P < .001). Conclusions: This is the first study to provide a tool for predicting ypN+ and prognosticate worse OS in primarily high-grade nmMIBC and could select patients for alternative neoadjuvant therapy and facilitate future study.

Published in Advances in Radiation Oncology

ISSN: 2452-1094 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: http://www.journals.elsevier.com/advances-in-radiation-oncology/

About the journal