Persistent lymph node uptake on [18 F]-FDG PET-CT after neoadjuvant chemotherapy: a major predictive factor of disease-free survival in MIBC

1. World J Urol. 2026 Jan 6;44(1):77. doi: 10.1007/s00345-025-06171-6.

Persistent lymph node uptake on [18 F]-FDG PET-CT after neoadjuvant
chemotherapy: a major predictive factor of disease-free survival in MIBC.

Pattou M(1), Robert G(2), Gouhizoun O(2), Guéna F(2), Khaddad A(2), Mebroukine
S(2), Margue G(2), Gross-Goupil M(3), Lefort F(3), Morgat C(4), Bernhard JC(2),
Bladou F(2), Klein C(2).

Author information:
(1)Department of Urology, University Hospital, Bordeaux, France.
.
(2)Department of Urology, University Hospital, Bordeaux, France.
(3)Department of Medical Oncology, University Hospital, Bordeaux, France.
(4)Nuclear Medicine department, University Hospital, Bordeaux, France.

INTRODUCTION: Locoregional lymph node involvement significantly worsens the
prognosis of muscle invasive urothelial carcinoma of the bladder. Depending on
disease burden, systemic chemotherapy is administered preoperatively either as a
neoadjuvant treatment for localized cases, or as induction systemic therapy,
when radiologic evidence suggests locoregional nodal involvement. Current lymph
node assessment relies on CT imaging, but the added value of [18 F]-FDG PET-CT
remains unclear. The objective of this study was to evaluate the prognostic
value of lymph node assessment using [18 F]-FDG PET-CT performed before and
after preoperative chemotherapy.
METHODS: We conducted a retrospective single-center study on consecutive
patients who received preoperative chemotherapy (neoadjuvant or induction
systemic therapy) followed by radical cystectomy for MIBC between 2017 and 2025.
Patients who underwent both pre and post-chemotherapy [18 F]-FDG PET-CT were
included and categorized into three groups based on nodal metabolic uptake,
before and after chemotherapy: (-)/(-), (+)/(-), and (+)/(+). The primary
objective was to assess disease-free survival (DFS) according to nodal [18
F]-FDG uptake before and after chemotherapy.
RESULTS: Forty-one patients were included, with a median age of 66 years (range
36-78), Preoperative chemotherapy consisted of ddMVAC in 65.9% of cases, with a
median of 4 cycles (range 1-6). Seven patients (17.1%) were ypN1 and three
(7.3%) were ypN2. At 7 months, all patients with persistent positive uptake
experienced disease progression. DFS was significantly lower in the (+)/(+)
group (log-rank p

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