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.
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.
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
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.
Urologic oncology. 2015 Sep 25 [Epub ahead of print]
Philip L Ho, Daniel L Willis, Jeevitha Patil, Lianchun Xiao, Stephen B Williams, Jonathan J Melquist, Karen Tart, Sahil Parikh, Jay B Shah, Scott E Delacroix, Neema Navai, Arlene Siefker-Radtke, Colin P Dinney, Louis L Pisters, Ashish M Kamat
Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX. , Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX. , Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX. , Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX. , Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX. , Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX. , Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX. , Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX. , Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX. , Department of Urology, Louisiana State University, New Orleans, LA. , Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX. , Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX. , Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX. , Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX. , Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX.