Induction chemotherapy followed by surgery in node positive bladder cancer
Meijer RP1, Mertens LS2, van Rhijn BW2, Bex A2, van der Poel HG2, Meinhardt W2, Kerst JM3, Bergman AM3, Fioole-Bruining A4, van Werkhoven E5, Horenblas S2. Urology. 2014 Jan;83(1):134-9. doi: 10.1016/j.urology.2013.08.082. Epub 2013 Nov 15.

Author information

1Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Urology, University Medical Center Utrecht, The Netherlands. Electronic address: rpmeijer111@yahoo.com. 2Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 3Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 4Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 5Department of Medical Statistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands.

Abstract

OBJECTIVE: To evaluate the outcome and prognostic factors of patients with node positive bladder cancer (NPBC), who were eligible for surgery and treated with induction chemotherapy.

METHODS: All consecutive patients with NPBC, who were treated with at least 2 cycles of induction chemotherapy and initially scheduled for surgery, between 1990 and 2012, were identified from an institutional bladder cancer database. Induction chemotherapy consisted of MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) or gemcitabine with cisplatin (Gem/Cis) or carboplatin (Gem/Carbo).

RESULTS: One hundred forty-nine patients with NPBC (mean age, 60 years; range, 31-79) were treated with induction chemotherapy. Median cancer-specific survival (CSS) was 20 months and 5-year CSS 29.2%. In case of complete pathologic response to induction chemotherapy (N = 40; 26.8%), median CSS was 127 months and 5-year CSS 63.5% (P <.0001). Clinical and pathologic responses to chemotherapy were predictive parameters with respect to CSS and recurrence-free survival. Combined local and nodal responses resulted in a significantly better outcome, compared with isolated nodal or local response (P <.0001).

CONCLUSION: Prognosis for NPBC remains poor despite the use of induction chemotherapy. Nevertheless, in the present series, 1 of 4 patients showed complete pathologic response to induction chemotherapy with subsequently a significant CSS benefit (median CSS 127 months and 5-year CSS 63.5%). Clinical and pathologic responses to chemotherapy are predictive parameters for outcome.