title: Could salvage surgery after chemotherapy have clinical impact on cancer survival of patients with metastatic urothelial carcinoma?
abstract: BACKGROUND
  The clinical impact of salvage surgery after chemotherapy on cancer survival of patients with metastatic urothelial carcinoma is controversial. We aimed to verify the clinical role of salvage surgery by analyzing the long-term outcome in patients with urothelial carcinoma treated by chemotherapy.
  
  
  METHODS
  Between 2003 and 2010 at a single institution, 31 of 47 patients (66%) with metastatic urothelial carcinoma showed objective responses (CR in 4, PR in 27) after multiple courses of cisplatin/gemcitabine/paclitaxel-based chemotherapy, and a cohort of patients with partial response (PR) were retrospectively enrolled. Twelve (10 male and 2 female, median age 64.0 years) of 27 patients with PR underwent salvage surgeries after the chemotherapy: metastatectomy of residual lesions (10 retroperitoneal lymph nodes, 2 lung), and 6 radical surgeries for primary lesions as well. Progression-free survival and overall patient survival rates were analyzed retrospectively and compared with those of patients without salvage surgery.
  
  
  RESULTS
  All 12 patients achieved surgical CR. Pathological findings of metastatic lesions showed viable cancer cells in 3 patients. In univariate analysis, sole salvage surgery affected overall survival in 27 patients with PR to the chemotherapy (P = 0.0037). Progression-free survival and overall survival rates in patients with salvage surgery were better than those in 15 PR patients without the surgery (39.8 vs. 0%, and 71.6 vs. 12.1% at 3 years, P = 0.01032 and 0.01048; log-rank test).
  
  
  CONCLUSIONS
  Salvage surgery for patients with residual tumor who achieve partial response to chemotherapy could have a possible impact on cancer survival.
authors.affiliation: Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Bekku
authors.forename: Takashi
authors.initials: T
authors.lastname: Saika
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Ryo
authors.initials: R
authors.lastname: Kioshimoto
authors.forename: Taiki
authors.initials: T
authors.lastname: Kanbara
authors.forename: Yasutomo
authors.initials: Y
authors.lastname: Nasu
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kumon
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D004358:Drug Therapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage; D016879:Salvage Therapy; D016896:Treatment Outcome; D019459:Urothelium / Q000473:pathology / Q000601:surgery*
chemical_list: D017239:Paclitaxel; D002945:Cisplatin
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