Quality of pathologic response and surgery correlate with survival for patients with completely resected bladder cancer after neoadjuvant chemotherapy |
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| Authors: | Guru Sonpavde MD Bryan H. Goldman MD V. O. Speights MD Seth P. Lerner MD David P. Wood MD Nicholas J. Vogelzang MD Donald L. Trump MD Ronald B. Natale MD H. Barton Grossman MD E. David Crawford MD |
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| Affiliation: | 1. Department of Medicine, Section of Medical Oncology, Baylor College of Medicine, Houston, Texas;2. Fax: (281) 332‐8429;3. Southwest Oncology Group Statistical Center, Seattle, Washington;4. Department of Medicine, Section of Medical Oncology, Scott and White Clinic, Temple, Texas;5. Department of Urology, University of Michigan, Ann Arbor, Michigan;6. Department of Medicine, Section of Medical Oncology, Nevada Cancer Institute, Las Vegas, Nevada;7. Department of Medicine, Section of Medical Oncology, Roswell Park Cancer Institute, Buffalo, New York;8. Department of Medicine, Section of Medical Oncology, Cedars‐Sinai Comprehensive Cancer Center, Los Angeles, California;9. Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas;10. Department of Urology, University of Colorado, Aurora, Colorado |
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| Abstract: | BACKGROUND: In a retrospective study of Southwestern Oncology Group (SWOG)‐S8710/INT‐0080 (radical cystectomy [RC] alone vs 3 cycles of neoadjuvant chemotherapy [NC] with methotrexate, vinblastine, doxorubicin, and cisplatin before RC for bladder cancer), factors found to be associated with improved overall survival (OS) included pathologic complete response, defined as P0; treatment with NC; completion of RC with negative surgical margins; and ≥10 pelvic lymph nodes (LNs) removed. METHODS: The authors used stratified Cox regression to retrospectively study the association of quality of pathologic response after RC with OS in the subset of S8710 patients who received NC and RC with negative surgical margins. RESULTS: Of 154 patients who received NC, 68 (44.2%) were P = .054); OS was significantly worse for patients with residual P2+ disease (P = .0006). LN–positive (LN+) disease was found to be associated with worse OS than LN–negative (LN?) disease (P = .0005). Patients with LN? disease (ie, those with <10 LNs removed) appeared to have inferior OS compared with those with 10+ LNs removed (P = .079). The combination of pre‐NC clinical stage and post‐RC pathologic stage was found to be predictive of OS (P < .0001). CONCLUSIONS: NC and RC with negative surgical margins for bladder cancer followed by pathologic P0 and LN? disease were found to correlate with improved OS. A combination of baseline clinical stage and post‐RC pathologic stage may better predict OS. Cancer 2009. © 2009 American Cancer Society. |
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| Keywords: | neoadjuvant chemotherapy bladder cancer pathologic complete response overall survival |
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