STOCKHOLM, SWEDEN (UroToday.com) - The aim of this multicenter study from Italy was to evaluate the effect of lymphadenectomy and its contribution to survival on patients who continue to have nodal positive disease after chemotherapy. Authors reported on 157 patients with locally advanced or metastatic urothelial cancer who received first-line combination of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) between 1986 and 2012.
Fifty-nine patients who experienced at least a stable disease with sub-diaphragmatic nodal disease or local recurrence only were included for analysis. Median follow up was 88 months (IQR: 24-211). Of these, 31 (52.5%) had regional nodes and 28 (47.5%) had metastatic disease. 42 (71.2%) had multiple nodal sites, 15 patients (25.4%) had an upper tract tumor primary, 24 (40.7%) had received major surgery. Twenty-eight patients underwent post-chemotherapy pelvic (N=14) or retroperitoneal lymphadenectomy (N=14) after achieving a complete response (CR, N=7) or a partial response-stable disease (PR+SD, N=21). Median progression-free (PFS) survival by treatment group (surgery vs observation) was 18 (95% CI) and 11 (95% CI) months, respectively (p=0.009). Median overall survival (OS) was 37 (95% CI) and 19 (95% CI) months, respectively (p=0.004). Even though surgical consolidation was associated with better PFS (HR: 0.43, 95% CI, 0.22-0.84, p=0.013) and OS (HR: 0.36, 95% CI, 0.17-0.76, p=0.007) in univariable analysis, on multivariable analysis, after adjusting for other variables, this was retained. No effect of pathologic status was found. Results are limited by small numbers.
Because of the small sample size, it is difficult to draw solid conclusions. However, perhaps in well-selected patients who show complete response to chemotherapy and have only node metastasis, lymphadenectomy can improve survival. Further studies with larger cohorts are needed.
Presented by Necchi, A., Lo Vullo, S., Giannatempo, P., Farè, E. Nicolai, N., Piva, L., Biasoni, D., Torelli, T., Catanzaro, M., Stagni, S., Crestani, A., Colecchia, M., Paolini, B., Gianni, A.M., Mariani, L, Maffezzini, M., and Salvioni, R. at the 29th Annual European Association of Urology (EAU) Congress - April 11 - 15, 2014 - Stockholmsmässan - Stockholm, Sweden.
Fondazione IRCCS - Istituto Nazionale Dei Tumori, Dept. of Medical Oncology, Milan, Italy, Fondazione IRCCS - Istituto Nazionale Dei Tumori, Dept. of Clinical Epidemiology and Trials Organization Unit, Milan, Italy, Fondazione IRCCS - Istituto Nazionale Dei Tumori, Dept. of Surgery Urology Unit, Milan, Italy, Fondazione IRCCS - Istituto Nazionale Dei Tumori, Dept. of Pathology, Milan, Italy
Written by Reza Mehrazin, MD, medical writer for UroToday.com