{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T08:20:39Z","timestamp":1785313239108,"version":"3.55.0"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T00:00:00Z","timestamp":1719187200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the lymph node invasion (LNI) rate in patients exhibiting complete pathological response (CR) to neoadjuvant chemotherapy (NAC) and to test the association of CR status with lower LNI and better survival outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      We included patients with bladder cancer (BCa; cT2\u20104a; cN0; cM0) treated with NAC and radical cystectomy (RC)\u2009+\u2009pelvic lymph node dissection (PLND) at our institution between 2012 and 2022 (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009157). CR (ypT0) and LNI (ypN+) were defined at final pathology. Univariable and multivariable logistic regression analysis was performed to test the association between CR and LNI after adjusting for number of lymph nodes removed (NLR). Kaplan\u2013Meier and Cox regression analyses were used to assess overall survival (OS), metastasis\u2010free survival (MFS) and disease free\u2010survival (DFS) according to CR status.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall CR and LNI rates were 40.1% and 19%, respectively. The median (interquartile range [IQR]) NLR was 26 (19\u201336). The LNI rate was lower in patients with CR vs those without CR (2 [3.2%] vs 61 [29.8%];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). After adjusting for NLR, CR reduced the LNI risk by 93% (odds ratio 0.07, 95% confidence interval [CI] 0.01\u20130.25;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Kaplan\u2013Meier plots depicted better 5\u2010year OS (69.7 vs 52.2%), MFS (68.3 vs 45.5%) and DFS (66.6 vs 43.5%) in patients with CR vs those without CR. After multivariable adjustments, CR independently reduced the risk of death (hazard ratio [HR] 0.44, 95% CI 0.24\u20130.81;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.008), metastatic progression (HR 0.41, 95% CI 0.23\u20130.71;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002) and disease progression (HR 0.41, 95% CI 0.24\u20130.70;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Based on these findings, we postulate that PLND could potentially be omitted in patients exhibiting CR after NAC, due to negligible risk of LNI. Prospective Phase II trials are needed to explore this challenging hypothesis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.16440","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T07:21:26Z","timestamp":1719213686000},"page":"976-981","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Assessing risk of lymph node invasion in complete responders to neoadjuvant chemotherapy for muscle\u2010invasive bladder cancer"],"prefix":"10.1111","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3129-0544","authenticated-orcid":false,"given":"Rocco Simone","family":"Flammia","sequence":"first","affiliation":[{"name":"Department of Urology IRCCS \u201cRegina Elena\u201d National Cancer Institute  Rome Italy"},{"name":"Department of Surgery Sapienza University of Rome  Rome 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