title: Outcome of patients with clinically node-positive bladder cancer undergoing consolidative surgery after preoperative chemotherapy: The M.D. Anderson Cancer Center Experience.
abstract: OBJECTIVE
  Patients with urothelial cancer with nodal metastasis have a poor prognosis, with many deemed incurable. We report outcomes of a prospective clinical protocol of patients with clinically node-positive disease treated via a multimodality treatment approach.
  
  
  METHODS
  A total of 55 patients with bladder urothelial carcinoma with concurrent node-positive disease including pelvic nodal and retroperitoneal lymph node (RPLN) involvement underwent preoperative chemotherapy followed by consolidative surgery between 1995 and 2010. Associations between clinicopathologic factors and outcomes were analyzed using log-rank test and Cox regression analysis.
  
  
  RESULTS
  Median cancer-specific survival (CSS) was 26 months (95% CI: 12.9-not applicable) for all patients. A total of 30 (55%) patients had pN0 category disease at the time of surgical extirpation. Despite radiologic complete response after chemotherapy, 6 of 21 patients (29%) had pN+category disease. The 5-year CSS rate was 66% for pN0 category disease vs. 12% for pN+category disease (P<0.001). Radiologic complete response to chemotherapy was associated with a 5-year CSS rate of 60% vs. 33% for a partial response (P = 0.038). Although no recurrences occurred within the lymphadenectomy template, 2 (14%) patients with cM1 RPLN disease who did not undergo RPLN dissection had recurrences in the RPLN basin and died within 6 months.
  
  
  CONCLUSIONS
  Multimodality treatment approach with upfront chemotherapy followed by surgery can result in a 66% 5-year CSS rate for patients rendered as having pN0 category disease despite initially presenting with node-positive disease. However, as those with residual disease do so poorly, further efforts in refining selection of patients for surgical consolidation are needed.
authors.affiliation: Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Philip L
authors.initials: PL
authors.lastname: Ho
authors.affiliation: Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Willis
authors.affiliation: Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Jeevitha
authors.initials: J
authors.lastname: Patil
authors.affiliation: Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Lianchun
authors.initials: L
authors.lastname: Xiao
authors.affiliation: Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Williams
authors.affiliation: Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Melquist
authors.affiliation: Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Karen
authors.initials: K
authors.lastname: Tart
authors.affiliation: Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Sahil
authors.initials: S
authors.lastname: Parikh
authors.affiliation: Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Jay B
authors.initials: JB
authors.lastname: Shah
authors.affiliation: Department of Urology, Louisiana State University, New Orleans, LA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Delacroix
authors.affiliation: Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Neema
authors.initials: N
authors.lastname: Navai
authors.affiliation: Department of Genitourinary Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Arlene
authors.initials: A
authors.lastname: Siefker-Radtke
authors.affiliation: Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Colin P
authors.initials: CP
authors.lastname: Dinney
authors.affiliation: Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Louis L
authors.initials: LL
authors.lastname: Pisters
authors.affiliation: Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX. Electronic address: akamat@mdanderson.org.
authors.forename: Ashish M
authors.initials: AM
authors.lastname: Kamat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004358:Drug Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Bladder cancer; Multimodality treatment approach; Node-positive disease; Preoperative chemotherapy; Surgical consolidation