title: The utility of an extensive postchemotherapy staging evaluation in patients receiving neoadjuvant chemotherapy for bladder cancer.
abstract: OBJECTIVE
  To assess the utility of an extensive restaging examination performed after the completion of neoadjuvant chemotherapy (NAC) but before radical cystectomy (RC) in the management of patients with advanced bladder cancer.
  
  
  METHODS
  We studied 62 patients who underwent NAC with the intent of proceeding to consolidative RC. A restaging examination, including endoscopic and bimanual examination, as well as cross-sectional imaging of the abdomen and pelvis, was performed after chemotherapy. The impact of restaging on clinical management was determined. In patients proceeding to RC, the degree of correlation between clinical stage (at diagnosis vs on restaging) and pathologic stage was determined.
  
  
  RESULTS
  Restaging altered the treatment course in 6 patients (9.7%) in whom RC was not performed because of restaging findings. An additional 56 patients (90.3%) proceeded to RC. In these patients, compared with clinical stage at diagnosis, the postchemotherapy clinical stage correlated more strongly with pathologic stage (κ = 0.02 vs 0.17). On multivariate analysis, diagnostic clinical stage was not associated with pathologic stage (P = .85), whereas postchemotherapy clinical stage was strongly predictive of pathologic stage (P <.01).
  
  
  CONCLUSIONS
  An extensive restaging examination altered treatment strategy in a small, but clinically significant subset of patients treated with NAC for bladder cancer. Furthermore, restaging allowed for more accurate prediction of pathologic stage after RC, thereby improving assessment of patient prognosis. Consideration should be given to incorporating a restaging evaluation into the standard management paradigm for bladder cancer.
authors: The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: adam.reese@tuhs.temple.edu.
authors: Adam C
authors: AC
authors: Reese
authors: The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Mark W
authors: MW
authors: Ball
authors: The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Nilay
authors: N
authors: Gandhi
authors: The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Michael A
authors: MA
authors: Gorin
authors: The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: George J
authors: GJ
authors: Netto
authors: The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Trinity J
authors: TJ
authors: Bivalacqua
authors: The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Mark P
authors: MP
authors: Schoenberg
mesh_terms: D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology*