title: Neoadjuvant chemotherapy in urothelial bladder cancer: impact of regimen and variant histology.
abstract: OBJECTIVE
  We compared the efficacy of methotrexate/vinblastine/doxorubicin/cisplatin (MVAC) versus gemcitabine/cisplatin in urothelial cancer and neoadjuvant chemotherapy (NACT) efficacy in variant histology (VH).
  
  
  METHODS
  Radical cystectomy patients were retrospectively compared with those who received NACT. Factors associated with survival, pathologic complete response (pCR) and downstaging (pDS) were evaluated in multivariable models.
  
  
  RESULTS
  9% of radical cystectomy patients (84/919) received NACT, with improved survival, pCR and pDS on both regimens. MVAC lead to higher pDS without an increase in pCR. On multivariable analysis, there was a nonsignificant increase in pDS with MVAC. NACT conferred similar responses in squamous and glandular differentiation VH.
  
  
  CONCLUSIONS
  NACT was associated with improved survival, pCR and pDS. Furthermore, responses to NACT were not dependent on presence of VH.
authors.affiliation: Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN 46202, USA.
authors.forename: Hristos Z
authors.initials: HZ
authors.lastname: Kaimakliotis
authors.affiliation: Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN 46202, USA.
authors.forename: M Francesca
authors.initials: MF
authors.lastname: Monn
authors.affiliation: Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN 46202, USA.
authors.forename: Jane S
authors.initials: JS
authors.lastname: Cho
authors.affiliation: Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN 46202, USA.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Pedrosa
authors.affiliation: Department of Genitourinary Medical Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Room 1M51, Baltimore, MD 21287, USA.
authors.forename: Noah M
authors.initials: NM
authors.lastname: Hahn
authors.affiliation: Department of Genitourinary Medical Oncology, Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN 46202, USA.
authors.forename: Costantine
authors.initials: C
authors.lastname: Albany
authors.affiliation: Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN 46202, USA.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Gellhaus
authors.affiliation: Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN 46202, USA.
authors.forename: K Clint
authors.initials: KC
authors.lastname: Cary
authors.affiliation: Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN 46202, USA.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Masterson
authors.affiliation: Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN 46202, USA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Foster
authors.affiliation: Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN 46202, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Bihrle
authors.affiliation: Department of Genitourinary Medical Oncology, Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN 46202, USA.
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
authors.affiliation: Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN 46202, USA.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Koch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000401:mortality; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D015653:Cystectomy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate; D000093542:Gemcitabine
keywords: bladder cancer; cystectomy; downstaging; neoadjuvant chemotherapy; pathologic response; variant histology