title: The importance of clinical stage among patients with a complete pathologic response at radical cystectomy after neoadjuvant chemotherapy.
abstract: OBJECTIVE
  Patients without evidence of disease at radical cystectomy (RC) following neoadjuvant chemotherapy (NAC) have the greatest potential for survival in muscle-invasive bladder cancer. Historically, 15 % of such patients will experience disease recurrence and cancer-specific mortality. We sought to evaluate the effect of pre-treatment clinical factors on the risk of recurrence in patients who were ypT0N0 at RC.
  
  
  METHODS
  We performed a multi-institutional review of patients treated with NAC + RC for muscle-invasive bladder cancer (≥cT2) without pathologic evidence of disease at surgery (ypT0N0). The association of pre-treatment clinicopathologic features with recurrence was evaluated using Cox proportional hazards.
  
  
  RESULTS
  A total of 78 patients were identified with ypT0 disease at RC after NAC. Median postoperative follow-up was 32.4 months (IQR 16.8, 60.0), during which time 17 patients recurred at a median of 6.4 months after RC. Estimated 3-year recurrence-free survival (RFS) of this cohort was 74.8 %. In univariate analysis, cT4 disease (HR 3.12; p = 0.04) and time to RC (HR 1.17 for each month increase; p < 0.01) were associated with inferior RFS.
  
  
  CONCLUSIONS
  Patients without evidence of disease at the time of RC are still at risk of recurrence and death from bladder cancer. Higher clinical stage and increased time to RC were associated with an increased risk of recurrence and subsequent death. These data highlight the importance of timely RC and the continued risk of recurrence in higher clinically staged patients-underscoring the need for close monitoring and patient counseling.
authors.affiliation: Department of Urology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: William P
authors.initials: WP
authors.lastname: Parker
authors.affiliation: Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 1373, Houston, TX, 77030, USA.
authors.forename: Philip L
authors.initials: PL
authors.lastname: Ho
authors.affiliation: Department of Urology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
authors.affiliation: Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 1373, Houston, TX, 77030, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Melquist
authors.affiliation: Department of Urology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Prabin
authors.initials: P
authors.lastname: Thapa
authors.affiliation: Department of Urology, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3016, Kansas City, KS, 66160, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Holzbeierlein
authors.affiliation: Department of Urology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Igor
authors.initials: I
authors.lastname: Frank
authors.affiliation: Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 1373, Houston, TX, 77030, USA.
authors.forename: Ashish M
authors.initials: AM
authors.lastname: Kamat
authors.affiliation: Department of Urology, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3016, Kansas City, KS, 66160, USA. elee@kumc.edu.
authors.forename: Eugene K
authors.initials: EK
authors.lastname: Lee
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents
keywords: Bladder cancer; Complete response; Neoadjuvant chemotherapy; Recurrence