A Multi-Institutional Analysis of Outcomes in Patients with Clinically Node Positive Urothelial Bladder Cancer Treated with Induction Chemotherapy and Radical Cystectomy

Selected bladder cancer patients with pelvic lymphadenopathy (cN1-3) are treated with induction chemotherapy followed by radical cystectomy (RC). However, the data on clinical outcomes in these patients are limited.

The aim of this project is to assess pathological and survival outcomes in cN1-3 patients treated with induction chemotherapy and RC.

Data were collected on patients from 19 North American and European centers with cT1-4aN1-N3 urothelial-carcinoma who received chemotherapy followed by RC between 2000-2013. The primary endpoints were pathological complete (pCR, pT0N0) and partial (pPR, pT≤1N0) response rates, and overall-survival (OS) was a secondary endpoint. Logistic-regression and Cox proportional hazard ratios were used for multivariate analysis of factors predicting these outcomes.

The total of 304 patients had clinical evidence of lymph node involvement (cN1-N3). MVAC was used in 128 (42%), GC in 132 (43%) and other regimens in 44 (15%) patients. The pN0 rate was 48% (cN1: 56%, cN2: 39%, cN3: 39%, p=0. 03). The pCR and pPR rates for the entire cohort were 14. 5% and 27% respectively. The estimated median OS time for the cohort was 22 months (IQR 8. 0, 54). On Cox regression analysis, OS was associated with pN0, negative surgical margins, removal of ≥15 pelvic nodes and cisplatin therapy.

Complete pathological nodal response can be achieved in a proportion of cN1-3 patients receiving induction chemotherapy. The best survival outcomes are observed in male patients receiving cisplatin regimens with subsequent negative RC margins and complete nodal response (pN0) with excision of ≥15 pelvic nodes.

The Journal of urology. 2015 Jul 20 [Epub ahead of print]

Kamran Zargar-Shoshtari, Homayoun Zargar, Yair Lotan, Jay B Shah, Bas W van Rhijn, Siamak Daneshmand, Philippe E Spiess, Peter Black

Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA. , Vancouver Prostate Centre, Vancouver, BC, Canada. , Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. , Department of Urology, MD Anderson Cancer Center, Houston, TX, USA. , Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. , USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, CA, USA. , Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa FL, USA. , Vancouver Prostate Centre, Vancouver, BC, Canada.

PubMed