Postchemotherapy consolidative surgery for metastatic urothelial carcinoma.

Abstract

362 Background: The role of post-chemotherapy consolidative surgery for metastatic urothelial carcinoma (UC) is controversial and supported by small, single-center series in select patients. We sought to assess our experience with post-chemo retroperitoneal lymph node (RPLN) dissection for primary metastatic or relapsed UC to the retroperitoneum (with or without concomitant cystectomy and/or nephroureterectomy). Methods: Since 2008, 15 patients with metastatic or relapsed UC of the bladder or upper tracts (UT) and associated RPLN metastases were considered for post-chemo consolidative surgery. Records were reviewed for response to therapy, final pathology, and impact of surgery on overall survival (OS). Chemo agents used were provider dependent with 9 patients treated with gemcitabine/cisplatin, 3 with gem/carboplatin, and 2 with methotrexate, vinblastine, doxorubicin, cisplatin (1 received a combination due to intolerance). A median of 3.5 cycles were given in the adjuvant (n=5) and induction (n=10) setting. Seven patients presented with UT disease, of those 3 with relapse; median follow-up was 31.6 months (mos, IQR 14, 72), with 1 patient deceased. Nine patients had a bladder primary, 5 had induction chemo (median follow-up: 22 mos, IQR 16, 40), with 1 alive, 4 dead of disease, and 2 of other causes. To date, 13 patients have undergone surgery. Overall median follow-up is 23 mos. Results: Five patients (3 bladder, 2 UT) were noted to have radiographic complete response (CR) with induction and a median survival of 21.5 mos, with one patient alive at 7 years. All but one patient in the UT group are alive. Two patients had pathological CR, both were in the bladder cohort and died at 8 and 23 mos post-op. For all other patients, final pathology noted a median of 2 LN positive for malignancy (average 3.6). Neither chemo nor timing of administration showed a difference in OS. Conclusions: There is a role for post-chemo consolidative surgery in selected patients with metastatic UC. Compared to patients with the primary tumor in the UT, those with a primary bladder tumor and RPLN fared worse with a shorter overall survival time. More studies are necessary to better define the role of surgery in this setting.