MP55-20 OUTCOME OF PATIENTS WITH CLINICALLY NODE-POSITIVE BLADDER CANCER WHO UNDERGO CONSOLIDATIVE SURGERY AFTER PRE-OPERATIVE CHEMOTHERAPY: MD ANDERSON CANCER CENTER EXPERIENCE

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive II1 Apr 2014MP55-20 OUTCOME OF PATIENTS WITH CLINICALLY NODE-POSITIVE BLADDER CANCER WHO UNDERGO CONSOLIDATIVE SURGERY AFTER PRE-OPERATIVE CHEMOTHERAPY: MD ANDERSON CANCER CENTER EXPERIENCE Philip Ho, Daniel Willis, Jeevitha Patil, Karen Tart, Sahil Parikh, Jay Shah, Scott Delacroix, Arlene Siefker-Radtke, Colin Dinney, Louis Pisters, and Ashish Kamat Philip HoPhilip Ho More articles by this author , Daniel WillisDaniel Willis More articles by this author , Jeevitha PatilJeevitha Patil More articles by this author , Karen TartKaren Tart More articles by this author , Sahil ParikhSahil Parikh More articles by this author , Jay ShahJay Shah More articles by this author , Scott DelacroixScott Delacroix More articles by this author , Arlene Siefker-RadtkeArlene Siefker-Radtke More articles by this author , Colin DinneyColin Dinney More articles by this author , Louis PistersLouis Pisters More articles by this author , and Ashish KamatAshish Kamat More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1568AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives We previously reported results of our phase II study in patients with retroperitoneal lymph node (RPLN) metastasis from bladder cancer (BC) undergoing consolidative surgery after pre-operative chemotherapy. Here we present an expanded cohort of patients who underwent consolidative surgery after chemotherapy for clinically node-positive BC. Methods We reviewed results of patients from our IRB approved protocol including those with clinical evidence of nodal metastasis in the pelvis or retroperitoneum (M1), without visceral metastasis, from 1995-2010. The endpoint of the study was cancer-specific survival (CSS) calculated from time of surgical consolidation. Results A total of 55 patients with either clinical pelvic lymph node (PLN) metastasis (n=29) or PLN and RPLN metastasis (n=26) were identified. Median CSS was 19 months for all patients; 21 for PLN alone and 16 for PLN and RPLN disease. Kaplan-Meier estimate of 5-year CSS was 31% for the entire group with no difference between PLN alone and PLN with RPLN disease. According to AJCC 2010 criteria, clinical nodal stage was N1: 16, N2: 5, N3: 8, and M1 (RPLN): 26. Majority (94%) of patients received cisplatinum-based chemotherapy. At cystectomy, all patients underwent a PLN dissection (PLND) with 12 patients (all clinical M1 RPLN) undergoing concurrent RPLN dissection (RPLND) to the renal hilum. In all, 30 of 55 (55%) patients were pN0 at the time of surgical extirpation while 26% (5 of 19) were pN+ despite radiologic complete response after chemotherapy. 5-year CSS was 57% for pN0 disease and 9% for pN+ disease (p<0.0001). Median survival in patients with residual tumor in PLN (n=17) was 10.5 months vs. 7 months for RPLN (n=8) (median survival was not reached in pN0 patients, p<0.001). 17 patients who developed recurrences outside the surgical field did so after a median of 8 months. While no recurrences occurred within the lymphadenectomy template, 2 of 14 (14%) patients with clinical M1 RPLN disease who did not undergo RPLND had recurrences in RPLN basin; both died within 6 months despite salvage chemotherapy. Conclusions Post-chemotherapy consolidative surgical resection may result in 5-year disease-free survival in patients with clinical evidence of node-positive disease, including those with RPLN positive disease, who have major response to chemotherapy. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e563 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Philip Ho More articles by this author Daniel Willis More articles by this author Jeevitha Patil More articles by this author Karen Tart More articles by this author Sahil Parikh More articles by this author Jay Shah More articles by this author Scott Delacroix More articles by this author Arlene Siefker-Radtke More articles by this author Colin Dinney More articles by this author Louis Pisters More articles by this author Ashish Kamat More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...