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

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Abstract

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.

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References

  1. International Collaboration of Trialists, Medical Research Council Advanced Bladder Cancer Working Party (now the National Cancer Research Institute Bladder Cancer Clinical Studies Group), European Organisation for Research and Treatment of Cancer Genito-Urinary Tract Cancer Group, Australian Bladder Cancer Study Group, National Cancer Institute of Canada Clinical Trials Group, Finnbladder, Norwegian Bladder Cancer Study Group, Club Urologico Espanol de Tratamiento Oncologico Group, Griffiths G, Hall R, Sylvester R et al. (2011) International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: long-term results of the BA06 30894 trial. J Clin Oncol 29:2171–2177

  2. Fosså SD, Sternberg C, Scher HI et al (1996) Survival of patients with advanced urothelial cancer treated with cisplatin-based chemotherapy. Br J Cancer 74:1655–1659

    Article  PubMed Central  PubMed  Google Scholar 

  3. Milowsky MI, Nanus DM, Maluf FC et al (2009) Final results of sequential doxorubicin plus gemcitabine and ifosfamide, paclitaxel, and cisplatin chemotherapy in patients with metastatic or locally advanced transitional cell carcinoma of the urothelium. J Clin Oncol 27:4062–4067

    Article  CAS  PubMed  Google Scholar 

  4. Dimopoulos MA, Finn L, Logothetis CJ (1994) Pattern of failure and survival of patients with metastatic urothelial tumors relapsing after cis-platinum-based chemotherapy. J Urol 151:598–600

    CAS  PubMed  Google Scholar 

  5. Nieuwenhuijzen JA, Bex A, Meinhardt W et al (2005) Neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin for histologically proven lymph node positive bladder cancer. J Urol 174:80–85

    Article  CAS  PubMed  Google Scholar 

  6. Sweeney P, Millikan R, Donat M et al (2003) Is there a therapeutic role for post-chemotherapy retroperitoneal lymph node dissection in metastatic transitional cell carcinoma of the bladder? J Urol 169:2113–2117

    Article  PubMed  Google Scholar 

  7. Kaag MG, Milowsky MI, Dalbagni G et al (2011) Regional lymph node status in patients with bladder cancer found to be pathological stage T0 at radical cystectomy following systemic chemotherapy. BJU Int 108:272–277

    Article  Google Scholar 

  8. Tsukamoto T, Yonese J, Ohkubo Y et al (2006) Phase I/II study of a combined gemcitabine, etoposide, and cisplatin chemotherapy regimen for metastatic urothelial carcinoma. Cancer 106:2363–2368

    Article  CAS  PubMed  Google Scholar 

  9. Urakami S, Fujii Y, Yamamoto S et al (2014) Phase II trial of first-line chemotherapy with gemcitabine, etoposide, and cisplatin for patients with advanced urothelial carcinoma. Urol Oncol 32:35e1–35.e7

    Article  Google Scholar 

  10. Dodd PM, McCaffrey JA, Herr H et al (1999) Outcome of postchemotherapy surgery after treatment with methotrexate, vinblastine, doxorubicin, and cisplatin in patients with unresectable or metastatic transitional cell carcinoma. J Clin Oncol 17:2546–2552

    CAS  PubMed  Google Scholar 

  11. Siefker-Radtke AO, Millikan RE, Tu SM et al (2002) Phase III trial of fluorouracil, interferon alpha-2b, and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in metastatic or unresectable urothelial cancer. J Clin Oncol 20:1361–1367

    Article  CAS  PubMed  Google Scholar 

  12. Calabrò F, Sternberg CN (2009) Neoadjuvant and adjuvant chemotherapy in muscle-invasive bladder cancer. Eur Urol 55:348–358

    Article  PubMed  Google Scholar 

  13. Lim MC, Song YJ, Seo SS et al (2010) Residual cancer stem cells after interval cytoreductive surgery following neoadjuvant chemotherapy could result in poor treatment outcomes for ovarian cancer. Onkologie 33:324–330

    Article  PubMed  Google Scholar 

  14. Meijer RP, Mertens LS, van Rhijn BW et al (2014) Induction chemotherapy followed by surgery in node positive bladder cancer. Urology 83:134–139

    Article  PubMed  Google Scholar 

  15. Rosenblatt R, Sherif A, Rintala E et al (2012) Pathologic downstaging is a surrogate marker for efficacy and increased survival following neoadjuvant chemotherapy and radical cystectomy for muscle-invasive urothelial bladder cancer. Eur Urol 61:1229–1238

    Article  PubMed  Google Scholar 

  16. Ghadjar P, Burkhard FC, Gautschi O et al (2011) Induction chemotherapy for unresectable urothelial carcinoma of the bladder. BJU Int 107:894–897

    Article  PubMed  Google Scholar 

  17. Siefker-Radtke AO, Dinney CP, Shen Y et al (2013) A phase 2 clinical trial of sequential neoadjuvant chemotherapy with ifosfamide, doxorubicin, and gemcitabine followed by cisplatin, gemcitabine, and ifosfamide in locally advanced urothelial cancer: final results. Cancer 119:540–547

    Article  CAS  PubMed  Google Scholar 

  18. Weight CJ, Garcia JA, Hansel DE et al (2009) Lack of pathologic down-staging with neoadjuvant chemotherapy for muscle-invasive urothelial carcinoma of the bladder: a contemporary series. Cancer 115:792–799

    Article  PubMed  Google Scholar 

  19. Zehnder P, Studer UE, Daneshmand S et al (2014) Outcomes of radical cystectomy with extended lymphadenectomy alone in patients with lymph node-positive bladder cancer who are unfit for or who decline adjuvant chemotherapy. BJU Int 113:554–560

    Article  PubMed  Google Scholar 

  20. Hautmann RE, de Petriconi RC, Pfeiffer C et al (2012) Radical cystectomy for urothelial carcinoma of the bladder without neoadjuvant or adjuvant therapy: long-term results in 1100 patients. Eur Urol 61:1039–1047

    Article  PubMed  Google Scholar 

  21. Kassouf W, Agarwal PK, Grossman HB et al (2009) Outcome of patients with bladder cancer with pN+ disease after preoperative chemotherapy and radical cystectomy. Urology 73:147–152

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Acknowledgments

This work was partly supported by the Smoking Research Foundation and Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology, Japan.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, 105-8470, Japan

    Shinji Urakami, Takeshi Yuasa, Shinya Yamamoto, Mizuaki Sakura, Hajime Tanaka, Tatsuro Hayashi, Sho Uehara, Yasushi Inoue, Yasuhisa Fujii, Hitoshi Masuda, Iwao Fukui & Junji Yonese

  2. Department of Urology, Federation of National Public Service Personnel Mutual Aid Associations, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan

    Shinji Urakami

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  1. Shinji Urakami
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  2. Takeshi Yuasa
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  3. Shinya Yamamoto
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  4. Mizuaki Sakura
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  5. Hajime Tanaka
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  6. Tatsuro Hayashi
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  7. Sho Uehara
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  8. Yasushi Inoue
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  9. Yasuhisa Fujii
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  10. Hitoshi Masuda
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  11. Iwao Fukui
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  12. Junji Yonese
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Corresponding author

Correspondence to Shinji Urakami.

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Urakami, S., Yuasa, T., Yamamoto, S. et al. Clinical response to induction chemotherapy predicts improved survival outcome in urothelial carcinoma with clinical lymph nodal metastasis treated by consolidative surgery. Int J Clin Oncol 20, 1171–1178 (2015). https://doi.org/10.1007/s10147-015-0839-y

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  • DOI: https://doi.org/10.1007/s10147-015-0839-y

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