Outcome of patients with clinically node-positive bladder cancer who undergo consolidative surgery after preoperative chemotherapy: MD Anderson Cancer Center experience.

Abstract

318 Background: 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 preoperative 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. Endpoint of the study was cancer-specific survival (CSS) calculated from time of surgery. Results: 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% with no difference between PLN alone and PLN with RPLN disease. 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 with 12 patients (all clinical M1 RPLN) undergoing concurrent RPLN dissection (RPLND). 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 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 not reached in pN0 patients, p< 0.001). 17 patients developed recurrences outside the surgical field after a median of 8 months. While no recurrences occurred within the lymphadenectomy template, 14% of patients with clinical M1 RPLN disease who did not undergo RPLND had recurrences in RPLN basin. 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.