Outcomes of radical cystectomy with extended lymphadenectomy alone in patients with lymph node‐positive bladder cancer who are unfit for or who decline adjuvant chemotherapy

Objective To analyse the long‐term outcomes of patients with lymph node (LN)‐positive bladder cancer, who did not receive any adjuvant therapy after radical cystectomy (RC) and extended pelvic lymph node dissection (ePLND). Patients and Methods We conducted a retrospective, combined cohort analysis based on two prospectively maintained cystectomy databases from the University of Southern California and the University of Bern. Eligible patients underwent RC with ePLND for cN0M0 disease but were found to have LN‐positive disease. No patient had neoadjuvant therapy, and all had negative surgical margins. Kaplan–Meier plots were used to estimate recurrence‐free survival (RFS) and overall survival (OS). Subgroup comparisons were performed using log‐rank tests, and multivariable analysis was based on Cox proportional hazard models. Results Of 521 patients with LN‐positive disease, 251 (48%) never received adjuvant therapy. Although the pathological stage distribution was similar, the 251 patients who did not receive adjuvant therapy were older and had both fewer total and positive LNs than those who underwent adjuvant therapy. The median RFS for patients treated with RC alone was 1.6 years. Recurrences mainly occurred