Management and outcome of muscle-invasive bladder cancer with clinical lymph node metastases. A nationwide population-based study in the bladder cancer data base Sweden (BladderBaSe)

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Purpose: To investigate the clinical management and outcome of patients with muscle-invasive bladder cancer with clinical lymph node involvement, using longitudinal nationwide population-based data. 

Methods: In the Bladder Cancer Data Base Sweden (BladderBaSe), treatment and survival in patients with urinary bladder cancer clinical stage T2–T4 N + M0 diagnosed between 1997 and 2014 was investigated. Patients´ characteristics were studied in relation to TNM classification, curative or palliative treatment, cancer-specific (CSS) and overall survival (OS). Age at diagnosis was categorised as ≤60, 61–70, 71–80 and >80 years, and time periods were stratified as follows: 1997–2001, 2002–2005, 2006–2010 and 2011–2014. 

Results: There were 786 patients (72% males) with a median age of 71 years (interquartile range = 64–79 years). The proportion of patients with high comorbidity increased over time. Despite similar low comorbidity, curative treatment was given to 44% and to 70% of those in older (>70 years) and younger age groups, respectively. Curative treatment decreased over time, but chemotherapy and cystectomy increased to 25% during the last time period. Patients with curative treatment had better survival compared to those with palliative treatment, both regarding CSS and OS in the whole cohort and in all age groups. 

Conclusions: The low proportion of older patients undergoing treatment with curative intent, despite no or limited comorbidity, indicates missed chances of treatment with curative intent. The reasons for an overall decrease in curative treatment over time need to be analysed and the challenge of coping with an increasing proportion of node-positive patients with clinically significant comorbidity needs to be met.


  • Firas Aljabery
  • Fredrik Liedberg
  • Christel Häggström
  • Viveka Ströck
  • Abolfazl Hosseini
  • Truls Gårdmark
  • Amir Sherif
  • Tomas Jerlström
  • Per Uno Malmström
  • Lars Holmberg
  • Oskar Hagberg
  • Staffan Jahnson
External organisations
  • Linköping University
  • Skåne University Hospital
  • Uppsala University
  • Umeå University
  • Sahlgrenska Academy
  • Sahlgrenska University Hospital
  • Karolinska University Hospital
  • Danderyd Hospital
  • Örebro University
  • King's College London
  • Karolinska Institutet
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Urology and Nephrology


  • Bladder cancer, cohort study, lymph node metastasis, management, outcome
Original languageEnglish
JournalScandinavian Journal of Urology
Publication statusPublished - 2019 Oct 30
Publication categoryResearch