Could salvage surgery after chemotherapy have clinical impact on cancer survival of patients with metastatic urothelial carcinoma?

Kensuke Bekku, Takashi Saika, Yasuyuki Kobayashi, Ryo Kioshimoto, Taiki Kanbara, Yasutomo Nasu, Hiromi Kumon

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: The clinical impact of salvage surgery after chemotherapy on cancer survival of patients with metastatic urothelial carcinoma is controversial. We aimed to verify the clinical role of salvage surgery by analyzing the long-term outcome in patients with urothelial carcinoma treated by chemotherapy. Methods: Between 2003 and 2010 at a single institution, 31 of 47 patients (66%) with metastatic urothelial carcinoma showed objective responses (CR in 4, PR in 27) after multiple courses of cisplatin/gemcitabine/paclitaxel- based chemotherapy, and a cohort of patients with partial response (PR) were retrospectively enrolled. Twelve (10 male and 2 female, median age 64.0 years) of 27 patients with PR underwent salvage surgeries after the chemotherapy: metastatectomy of residual lesions (10 retroperitoneal lymph nodes, 2 lung), and 6 radical surgeries for primary lesions as well. Progression-free survival and overall patient survival rates were analyzed retrospectively and compared with those of patients without salvage surgery. Results: All 12 patients achieved surgical CR. Pathological findings of metastatic lesions showed viable cancer cells in 3 patients. In univariate analysis, sole salvage surgery affected overall survival in 27 patients with PR to the chemotherapy (P = 0.0037). Progression-free survival and overall survival rates in patients with salvage surgery were better than those in 15 PR patients without the surgery (39.8 vs. 0%, and 71.6 vs. 12.1% at 3 years, P = 0.01032 and 0.01048; log-rank test). Conclusions: Salvage surgery for patients with residual tumor who achieve partial response to chemotherapy could have a possible impact on cancer survival.

Original languageEnglish
Pages (from-to)110-115
Number of pages6
JournalInternational Journal of Clinical Oncology
Volume18
Issue number1
DOIs
Publication statusPublished - Feb 2013

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Carcinoma
Drug Therapy
Survival
Neoplasms
gemcitabine
Disease-Free Survival
Survival Rate
Residual Neoplasm
Lymph Nodes
Lung

Keywords

  • Chemotherapy
  • Metastatectomy
  • Metastatic urothelial carcinoma
  • Salvage surgery
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Oncology
  • Surgery
  • Hematology

Cite this

Could salvage surgery after chemotherapy have clinical impact on cancer survival of patients with metastatic urothelial carcinoma? / Bekku, Kensuke; Saika, Takashi; Kobayashi, Yasuyuki; Kioshimoto, Ryo; Kanbara, Taiki; Nasu, Yasutomo; Kumon, Hiromi.

In: International Journal of Clinical Oncology, Vol. 18, No. 1, 02.2013, p. 110-115.

Research output: Contribution to journalArticle

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abstract = "Background: The clinical impact of salvage surgery after chemotherapy on cancer survival of patients with metastatic urothelial carcinoma is controversial. We aimed to verify the clinical role of salvage surgery by analyzing the long-term outcome in patients with urothelial carcinoma treated by chemotherapy. Methods: Between 2003 and 2010 at a single institution, 31 of 47 patients (66{\%}) with metastatic urothelial carcinoma showed objective responses (CR in 4, PR in 27) after multiple courses of cisplatin/gemcitabine/paclitaxel- based chemotherapy, and a cohort of patients with partial response (PR) were retrospectively enrolled. Twelve (10 male and 2 female, median age 64.0 years) of 27 patients with PR underwent salvage surgeries after the chemotherapy: metastatectomy of residual lesions (10 retroperitoneal lymph nodes, 2 lung), and 6 radical surgeries for primary lesions as well. Progression-free survival and overall patient survival rates were analyzed retrospectively and compared with those of patients without salvage surgery. Results: All 12 patients achieved surgical CR. Pathological findings of metastatic lesions showed viable cancer cells in 3 patients. In univariate analysis, sole salvage surgery affected overall survival in 27 patients with PR to the chemotherapy (P = 0.0037). Progression-free survival and overall survival rates in patients with salvage surgery were better than those in 15 PR patients without the surgery (39.8 vs. 0{\%}, and 71.6 vs. 12.1{\%} at 3 years, P = 0.01032 and 0.01048; log-rank test). Conclusions: Salvage surgery for patients with residual tumor who achieve partial response to chemotherapy could have a possible impact on cancer survival.",
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AU - Nasu, Yasutomo

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