Induction chemotherapy followed by surgery in node positive bladder cancer.
OBJECTIVE
To evaluate the outcome and prognostic factors of patients with node positive bladder cancer (NPBC), who were eligible for surgery and treated with induction chemotherapy.


METHODS
All consecutive patients with NPBC, who were treated with at least 2 cycles of induction chemotherapy and initially scheduled for surgery, between 1990 and 2012, were identified from an institutional bladder cancer database. Induction chemotherapy consisted of MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) or gemcitabine with cisplatin (Gem/Cis) or carboplatin (Gem/Carbo).


RESULTS
One hundred forty-nine patients with NPBC (mean age, 60 years; range, 31-79) were treated with induction chemotherapy. Median cancer-specific survival (CSS) was 20 months and 5-year CSS 29.2%. In case of complete pathologic response to induction chemotherapy (N = 40; 26.8%), median CSS was 127 months and 5-year CSS 63.5% (P <.0001). Clinical and pathologic responses to chemotherapy were predictive parameters with respect to CSS and recurrence-free survival. Combined local and nodal responses resulted in a significantly better outcome, compared with isolated nodal or local response (P <.0001).


CONCLUSIONS
Prognosis for NPBC remains poor despite the use of induction chemotherapy. Nevertheless, in the present series, 1 of 4 patients showed complete pathologic response to induction chemotherapy with subsequently a significant CSS benefit (median CSS 127 months and 5-year CSS 63.5%). Clinical and pathologic responses to chemotherapy are predictive parameters for outcome.
Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Urology, University Medical Center Utrecht, The Netherlands. Electronic address: rpmeijer111@yahoo.com.
Richard P
RP
Meijer
Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Laura S
LS
Mertens
Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Bas W
BW
van Rhijn
Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Axel
A
Bex
Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Henk G
HG
van der Poel
Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Wim
W
Meinhardt
Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
J Martijn
JM
Kerst
Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Andre M
AM
Bergman
Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Annemarie
A
Fioole-Bruining
Department of Medical Statistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Erik
E
van Werkhoven
Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Simon
S
Horenblas
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*