title: Clinical response to induction chemotherapy predicts improved survival outcome in urothelial carcinoma with clinical lymph nodal metastasis treated by consolidative surgery.
abstract: BACKGROUND
  To determine the indications for post-chemotherapy consolidative surgery in patients with clinical lymph node (LN) metastatic (cN+) urothelial carcinoma (UC).
  
  
  METHODS
  Sixty UC patients with measurable cN+ but without detectable systemic visceral/bone dissemination received induction platinum-based chemotherapy. Consolidative surgery was offered to all patients except for those with progressive disease. We retrospectively analyzed the clinicopathological response to induction chemotherapy and identified prognostic factors for overall survival (OS).
  
  
  RESULTS
  The primary cancer site was the urinary bladder in 31 patients (52 %) and upper urinary tract in 29 (48 %). The median number of chemotherapy courses was 4. Forty-five patients (75 %) showed a clinically objective response to the induction chemotherapy. Fifty-one patients (85 %) underwent subsequent consolidative surgery. Histopathological analysis indicated pT0 status in 10 (20 %) and pN0 in 17 (33 %). When all 60 patients were considered, clinical tumor response was found to be significantly correlated with achievement of pathological complete response. At the median follow-up of 22 months, the median progression-free survival and OS periods were excellent: 18.6 and 31.6 months, respectively. In the multivariate analysis, clinical tumor response was found to be an independent pre-surgical prognostic factor for OS, and pathologically negative lymph node, negative resection margin, more LNs removed, and negative lymphovascular invasion were found to be independent post-surgical prognostic parameters for OS.
  
  
  CONCLUSIONS
  The median OS in induction chemotherapy followed by consolidative surgery was very encouraging. Our results suggest that achieving a good clinical response to pre-surgical induction chemotherapy is a good indication for subsequent consolidative surgery in UC patients with cN+ to improve OS through a good pathological response.
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, 105-8470, Japan. shinurakami@ybb.ne.jp.|Department of Urology, Federation of National Public Service Personnel Mutual Aid Associations, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. shinurakami@ybb.ne.jp.
authors.forename: Shinji
authors.initials: S
authors.lastname: Urakami
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, 105-8470, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yuasa
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, 105-8470, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, 105-8470, Japan.
authors.forename: Mizuaki
authors.initials: M
authors.lastname: Sakura
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, 105-8470, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, 105-8470, Japan.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, 105-8470, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Uehara
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, 105-8470, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, 105-8470, Japan.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, 105-8470, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Masuda
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, 105-8470, Japan.
authors.forename: Iwao
authors.initials: I
authors.lastname: Fukui
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, 105-8470, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Yonese
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D018365:Neoplasm, Residual; D017671:Platinum Compounds / Q000008:administration & dosage; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*
chemical_list: D017671:Platinum Compounds
keywords: Consolidative surgery; Induction chemotherapy; Lymph node metastasis; Multimodality treatment; Urothelial carcinoma