Outcome of Patients With Bladder Cancer With pN+ Disease After Preoperative Chemotherapy and Radical Cystectomy
| Autor: | Mark F. Munsell, H. Barton Grossman, Piyush K. Agarwal, Colin P.N. Dinney, Wassim Kassouf, Louis L. Pisters, Arlene O. Siefker-Radtke, David A. Swanson, Ashish M. Kamat, Dan Leibovici |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Oncology medicine.medical_specialty Surgical margin Lymphovascular invasion Urology medicine.medical_treatment Cystectomy Preoperative care Article Internal medicine Preoperative Care medicine Carcinoma Humans Survival rate Aged Neoplasm Staging Retrospective Studies Aged 80 and over Carcinoma Transitional Cell Bladder cancer business.industry Retrospective cohort study Middle Aged medicine.disease Combined Modality Therapy Treatment Outcome Urinary Bladder Neoplasms Lymphatic Metastasis Female business |
| Zdroj: | Urology. 73:147-152 |
| ISSN: | 0090-4295 |
| Popis: | Objectives Persistent nodal disease in the surgical specimen (pN+) after preoperative chemotherapy for urothelial carcinoma is associated with a poor prognosis. To improve our understanding regarding the outcomes of such patients, we performed a retrospective review of our experience. Methods From 1993 to 2003, 857 patients underwent radical cystectomy for urothelial carcinoma of the bladder, and 150 were found to have pN+ disease. Of these 150 patients, 37 had pN+ disease despite preoperative chemotherapy and formed the basis of this report. The survival data were analyzed using the Kaplan-Meier method and Cox regression analysis. Results The median patient age was 66 years (range 39-85), and the median follow-up was 50 months (range 13.0-58.7). The clinical stage at the initiation of preoperative chemotherapy was cT2 with lymphovascular invasion in 7, cT3b in 6, cT4a in 4, cT4b in 2, and cN+ in 18. The 2-year overall, disease-specific, and recurrence-free survival rate was 20%, 29.2%, and 13.5%, respectively. Of the 37 patients, 11 (30%) received adjuvant chemotherapy after surgery, most (73%) were platinum-based regimens. On Kaplan-Meier analysis, adjuvant chemotherapy was associated with improved recurrence-free and disease-specific survival. On multivariate analysis, surgical margin status, sex, and histologic type were significantly associated with overall survival, and the histologic type and use of adjuvant chemotherapy were significantly associated with recurrence-free survival. Conclusions Patients with persistent nodal disease despite preoperative chemotherapy have a poor prognosis. A cohort of such patients might do well with adjuvant chemotherapy. The lymph node density and pT category were not prognostic in patients with nodal metastasis after preoperative chemotherapy. |
| Databáze: | OpenAIRE |
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