TY - JOUR
T1 - Outcome of patients with clinically node-positive bladder cancer undergoing consolidative surgery after preoperative chemotherapy
T2 - The M.D. Anderson Cancer Center Experience
AU - Ho, Philip L.
AU - Willis, Daniel L.
AU - Patil, Jeevitha
AU - Xiao, Lianchun
AU - Williams, Stephen B.
AU - Melquist, Jonathan J.
AU - Tart, Karen
AU - Parikh, Sahil
AU - Shah, Jay B.
AU - Delacroix, Scott E.
AU - Navai, Neema
AU - Siefker-Radtke, Arlene
AU - Dinney, Colin P.
AU - Pisters, Louis L.
AU - Kamat, Ashish M.
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Purpose Patients with urothelial cancer with nodal metastasis have a poor prognosis, with many deemed incurable. We report outcomes of a prospective clinical protocol of patients with clinically node-positive disease treated via a multimodality treatment approach. Patients and methods A total of 55 patients with bladder urothelial carcinoma with concurrent node-positive disease including pelvic nodal and retroperitoneal lymph node (RPLN) involvement underwent preoperative chemotherapy followed by consolidative surgery between 1995 and 2010. Associations between clinicopathologic factors and outcomes were analyzed using log-rank test and Cox regression analysis. Results Median cancer-specific survival (CSS) was 26 months (95% CI: 12.9–not applicable) for all patients. A total of 30 (55%) patients had pN0 category disease at the time of surgical extirpation. Despite radiologic complete response after chemotherapy, 6 of 21 patients (29%) had pN+category disease. The 5-year CSS rate was 66% for pN0 category disease vs. 12% for pN+category disease (P<0.001). Radiologic complete response to chemotherapy was associated with a 5-year CSS rate of 60% vs. 33% for a partial response (P = 0.038). Although no recurrences occurred within the lymphadenectomy template, 2 (14%) patients with cM1 RPLN disease who did not undergo RPLN dissection had recurrences in the RPLN basin and died within 6 months. Conclusion Multimodality treatment approach with upfront chemotherapy followed by surgery can result in a 66% 5-year CSS rate for patients rendered as having pN0 category disease despite initially presenting with node-positive disease. However, as those with residual disease do so poorly, further efforts in refining selection of patients for surgical consolidation are needed.
AB - Purpose Patients with urothelial cancer with nodal metastasis have a poor prognosis, with many deemed incurable. We report outcomes of a prospective clinical protocol of patients with clinically node-positive disease treated via a multimodality treatment approach. Patients and methods A total of 55 patients with bladder urothelial carcinoma with concurrent node-positive disease including pelvic nodal and retroperitoneal lymph node (RPLN) involvement underwent preoperative chemotherapy followed by consolidative surgery between 1995 and 2010. Associations between clinicopathologic factors and outcomes were analyzed using log-rank test and Cox regression analysis. Results Median cancer-specific survival (CSS) was 26 months (95% CI: 12.9–not applicable) for all patients. A total of 30 (55%) patients had pN0 category disease at the time of surgical extirpation. Despite radiologic complete response after chemotherapy, 6 of 21 patients (29%) had pN+category disease. The 5-year CSS rate was 66% for pN0 category disease vs. 12% for pN+category disease (P<0.001). Radiologic complete response to chemotherapy was associated with a 5-year CSS rate of 60% vs. 33% for a partial response (P = 0.038). Although no recurrences occurred within the lymphadenectomy template, 2 (14%) patients with cM1 RPLN disease who did not undergo RPLN dissection had recurrences in the RPLN basin and died within 6 months. Conclusion Multimodality treatment approach with upfront chemotherapy followed by surgery can result in a 66% 5-year CSS rate for patients rendered as having pN0 category disease despite initially presenting with node-positive disease. However, as those with residual disease do so poorly, further efforts in refining selection of patients for surgical consolidation are needed.
KW - Bladder cancer
KW - Multimodality treatment approach
KW - Node-positive disease
KW - Preoperative chemotherapy
KW - Surgical consolidation
UR - http://www.scopus.com/inward/record.url?scp=84978472274&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84978472274&partnerID=8YFLogxK
U2 - 10.1016/j.urolonc.2015.08.012
DO - 10.1016/j.urolonc.2015.08.012
M3 - Article
C2 - 26421586
AN - SCOPUS:84978472274
SN - 1078-1439
VL - 34
SP - 59.e1-59.e8
JO - Urologic Oncology: Seminars and Original Investigations
JF - Urologic Oncology: Seminars and Original Investigations
IS - 2
ER -