The role of local definitive therapy in addition to systemic treatment in clinically positive regional lymph node (cN+) bladder cancer is yet to be determined. Herein, we sought to investigate the role of radical cystectomy (RC) in management of patients with cN+ bladder cancer at US Veterans Health Administration Facilities. We identified patients diagnosed with cN+ bladder cancer between 2000-2017 using the Department of Veterans Affairs (VA) Informatics and Computing Infrastructure (VINCI). We employed a combination of database/registry coded values and chart review for data collection. To minimize mortality bias, we excluded patients who died within 90 days of diagnosis. We divided the patients into cystectomy (C) versus “no cystectomy” (NOC) cohorts. Propensity score matching was performed based on predictors of undergoing RC. Multivariable Cox models and Kaplan-Meier survival curves were used to estimate overall survival (OS) and cancer specific survival (CCS). After matching, 158 patients were included in the C and NOC groups. In the C-group, 85(54%) patients received pre-cystectomy chemotherapy, and 73(46%) patients underwent post-cystectomy chemotherapy. In the C-group, 65(41%) patients and in the NOC-group, 66(42%) patients had clinical N1 disease ( = .77). In multivariable Cox model, undergoing RC was associated with improved OS (HR0.62; 95%CI 0.47-0.81), < .001) and CSS (HR0.58; 95%CI 0.42-0.80; < .001). As part of multimodal treatment, undergoing RC was associated with improved OS and CSS in subset of patients with cN+ bladder cancer. Prospective randomized trials are warranted to further investigate the role of local definitive therapy in this specific patient population.

中文翻译：

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根治性膀胱切除术在临床淋巴结阳性膀胱癌中的作用：美国退伍军人健康管理局的一项研究

对于临床阳性区域淋巴结 (cN+) 膀胱癌，除了全身治疗外，局部根治性治疗的作用尚未确定。在此，我们试图研究根治性膀胱切除术 (RC) 在美国退伍军人健康管理机构治疗 cN+ 膀胱癌患者中的作用。我们使用退伍军人事务部 (VA) 信息学和计算基础设施 (VINCI) 确定了 2000 年至 2017 年间诊断出患有 cN+ 膀胱癌的患者。我们结合使用数据库/注册表编码值和图表审查来收集数据。为了最大限度地减少死亡率偏差，我们排除了诊断后 90 天内死亡的患者。我们将患者分为膀胱切除术（C）组和“无膀胱切除术”（NOC）组。根据接受 RC 的预测因素进行倾向评分匹配。多变量 Cox 模型和 Kaplan-Meier 生存曲线用于估计总生存期 (OS) 和癌症特异性生存期 (CCS)。匹配后，158 名患者被纳入 C 组和 NOC 组。在C组中，85例（54%）患者接受了膀胱切除术前化疗，73例（46%）患者接受了膀胱切除术后化疗。在 C 组中，有 65 名患者 (41%)，在 NOC 组中，有 66 名患者 (42%) 患有临床 N1 疾病 (= 0.77)。在多变量 Cox 模型中，接受 RC 与 OS（HR0.62；95%CI 0.47-0.81），< .001）和 CSS（HR0.58；95%CI 0.42-0.80；< .001）改善相关。作为多模式治疗的一部分，接受 RC 与 cN+ 膀胱癌患者亚组的 OS 和 CSS 改善相关。有必要进行前瞻性随机试验来进一步研究局部确定性治疗在这一特定患者群体中的作用。