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.
journal_name
Int J Clin Oncoljournal_title
International journal of clinical oncologyauthors
Urakami S,Yuasa T,Yamamoto S,Sakura M,Tanaka H,Hayashi T,Uehara S,Inoue Y,Fujii Y,Masuda H,Fukui I,Yonese Jdoi
10.1007/s10147-015-0839-ysubject
Has Abstractpub_date
2015-12-01 00:00:00pages
1171-8issue
6eissn
1341-9625issn
1437-7772pii
10.1007/s10147-015-0839-yjournal_volume
20pub_type
杂志文章abstract::The identification and validation of putative surrogate endpoints in oncology is a great challenge to medical investigators, statisticians, and regulators. A putative surrogate endpoint must be validated at both individual-level and trial-level before it can be used to replace the clinical endpoint in a future clinica...
journal_title:International journal of clinical oncology
pub_type: 杂志文章,评审
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更新日期:2005-04-01 00:00:00
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journal_title:International journal of clinical oncology
pub_type: 杂志文章
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