Clinical response to induction chemotherapy predicts improved survival outcome in urothelial carcinoma with clinical lymph nodal metastasis treated by consolidative surgery

• Published in: International journal of clinical oncology 2015-12, Vol.20 (6), p.1171-1178
• Main Authors: Urakami, Shinji, Yuasa, Takeshi, Yamamoto, Shinya, Sakura, Mizuaki, Tanaka, Hajime, Hayashi, Tatsuro, Uehara, Sho, Inoue, Yasushi, Fujii, Yasuhisa, Masuda, Hitoshi, Fukui, Iwao, Yonese, Junji
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer; Cancer Research; Carcinoma, Transitional Cell - mortality; Carcinoma, Transitional Cell - secondary; Carcinoma, Transitional Cell - therapy; Chemotherapy; Chemotherapy, Adjuvant; Disease-Free Survival; Female; Humans; Induction Chemotherapy; Lymph Node Excision; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Lymphatic system; Male; Medicine; Medicine & Public Health; Metastasis; Middle Aged; Neoadjuvant Therapy; Neoplasm Invasiveness; Neoplasm, Residual; Oncology; Original Article; Platinum Compounds - administration & dosage; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Treatment Outcome; Urologic Neoplasms - mortality; Urologic Neoplasms - pathology; Urologic Neoplasms - therapy
• ISSN: 1341-9625; 1437-7772
• DOI: 10.1007/s10147-015-0839-y

Background To determine the indications for post-chemotherapy consolidative surgery in patients with clinical lymph node (LN) metastatic (cN+) urothelial carcinoma (UC). Methods Sixty UC patients with measurable cN+ but without detectable systemic visceral/bone dissemination received induction platinum-based chemotherapy. Consolidative surgery was offered to all patients except for those with progressive disease. We retrospectively analyzed the clinicopathological response to induction chemotherapy and identified prognostic factors for overall survival (OS). Results The primary cancer site was the urinary bladder in 31 patients (52 %) and upper urinary tract in 29 (48 %). The median number of chemotherapy courses was 4. Forty-five patients (75 %) showed a clinically objective response to the induction chemotherapy. Fifty-one patients (85 %) underwent subsequent consolidative surgery. Histopathological analysis indicated pT0 status in 10 (20 %) and pN0 in 17 (33 %). When all 60 patients were considered, clinical tumor response was found to be significantly correlated with achievement of pathological complete response. At the median follow-up of 22 months, the median progression-free survival and OS periods were excellent: 18.6 and 31.6 months, respectively. In the multivariate analysis, clinical tumor response was found to be an independent pre-surgical prognostic factor for OS, and pathologically negative lymph node, negative resection margin, more LNs removed, and negative lymphovascular invasion were found to be independent post-surgical prognostic parameters for OS. Conclusions The median OS in induction chemotherapy followed by consolidative surgery was very encouraging. Our results suggest that achieving a good clinical response to pre-surgical induction chemotherapy is a good indication for subsequent consolidative surgery in UC patients with cN+ to improve OS through a good pathological response.