PMID- 27814469
OWN - NLM
STAT- MEDLINE
DCOM- 20170731
LR  - 20171230
IS  - 1879-0852 (Electronic)
IS  - 0959-8049 (Linking)
VI  - 69
DP  - 2016 Dec
TI  - Pathological downstaging and survival after induction chemotherapy and radical
      cystectomy for clinically node-positive bladder cancer-Results of a nationwide
      population-based study.
PG  - 1-8
LID - S0959-8049(16)32446-7 [pii]
LID - 10.1016/j.ejca.2016.09.015 [doi]
AB  - BACKGROUND: Induction chemotherapy (IC) for clinically node-positive bladder
      cancer is applied without clinical evidence of improved outcome. Our objective
      was to compare complete pathological downstaging (pCD) and overall survival (OS) 
      for IC versus upfront radical cystectomy (RC) in cT1-4aN1-3M0 urothelial
      carcinoma (UC). METHODS: This population-based study included 659 cN+ patients
      treated with RC between 1995 and 2013. IC was applied in 212 (32%) patients. We
      defined pCD as </=(y)pT1N0 at RC. Multivariable analyses were preformed to
      identify independent predictors of pCD and OS. RESULTS: In cN1 and cN2-3
      patients, 31% and 19% of patients proved to be pN0 at upfront RC. In cN1, pCD was
      achieved in 39% following IC versus 5% for upfront RC (P < 0.001). In cN2-3 UC,
      rates were 27% versus 3% (P < 0.001). Three-year OS for pCD and ypCD were 81% and
      84%, respectively. Three-year OS rates were 66% versus 37% (cN1) and 43% versus
      22% (cN2-3), again in favour of IC (P < 0.001). In multivariable analyses, IC was
      associated with pCD (Odds ratio, 14; 95% confidence interval [CI], 7.4-25) and a 
      53% decreased risk of death (Hazard ratio [HR], 0.47; 95% CI, 0.36-0.61).
      Indication bias and unequal distributions of factors associated with OS (e.g.
      patients proceeding to RC) limit interpretation of our results. CONCLUSIONS:
      Patients with clinical nodal involvement should not be neglected. Up to 1/4 of
      patients with cN+ disease had pN0 at upfront RC. Moreover, IC followed by RC for 
      clinically node-positive UC was associated with improved pathological downstaging
      compared with RC alone. A potential OS benefit for IC needs to be validated in a 
      randomised trial. TAKE HOME MESSAGE: IC followed by RC for clinically
      node-positive UC is associated with improved pathological downstaging compared
      with RC alone. A potential OS benefit for IC needs to be validated in a
      randomised trial.
CI  - Copyright A(c) 2016 Elsevier Ltd. All rights reserved.
FAU - Hermans, Tom J N
AU  - Hermans TJ
AD  - Department of Surgical Oncology, Division of Urology, Netherlands Cancer
      Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
FAU - Fransen van de Putte, Elisabeth E
AU  - Fransen van de Putte EE
AD  - Department of Surgical Oncology, Division of Urology, Netherlands Cancer
      Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
FAU - Horenblas, Simon
AU  - Horenblas S
AD  - Department of Surgical Oncology, Division of Urology, Netherlands Cancer
      Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
FAU - Meijer, Richard P
AU  - Meijer RP
AD  - Department of Urology, University Medical Center Utrecht, Utrecht, The
      Netherlands.
FAU - Boormans, Joost L
AU  - Boormans JL
AD  - Department of Urology, Erasmus University Medical Centre, Rotterdam, The
      Netherlands.
FAU - Aben, Katja K H
AU  - Aben KK
AD  - Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht,
      The Netherlands; Radboud Institute for Health Sciences, Radboud University
      Medical Centre, Nijmegen, The Netherlands.
FAU - van der Heijden, Michiel S
AU  - van der Heijden MS
AD  - Department of Medical Oncology, Netherlands Cancer Institute - Antoni van
      Leeuwenhoek Hospital, Amsterdam, The Netherlands.
FAU - de Wit, Ronald
AU  - de Wit R
AD  - Department of Medical Oncology, Erasmus University Medical Centre, Rotterdam, The
      Netherlands.
FAU - Beerepoot, Laurens V
AU  - Beerepoot LV
AD  - Department of Medical Oncology, Elisabeth-TweeSteden Hospital, Tilburg, The
      Netherlands.
FAU - Verhoeven, Rob H A
AU  - Verhoeven RH
AD  - Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht,
      The Netherlands.
FAU - van Rhijn, Bas W G
AU  - van Rhijn BW
AD  - Department of Surgical Oncology, Division of Urology, Netherlands Cancer
      Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
      Electronic address: basvanrhijn@hotmail.com.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20161027
PL  - England
TA  - Eur J Cancer
JT  - European journal of cancer (Oxford, England : 1990)
JID - 9005373
SB  - IM
MH  - Aged
MH  - Carcinoma, Transitional Cell/mortality/pathology/*therapy
MH  - *Cystectomy
MH  - Disease-Free Survival
MH  - Female
MH  - Humans
MH  - *Induction Chemotherapy
MH  - Kaplan-Meier Estimate
MH  - Logistic Models
MH  - Lymph Nodes/*pathology
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - *Neoadjuvant Therapy
MH  - Neoplasm Staging
MH  - Netherlands
MH  - Odds Ratio
MH  - Proportional Hazards Models
MH  - *Registries
MH  - Survival Rate
MH  - Treatment Outcome
MH  - Urinary Bladder Neoplasms/mortality/pathology/*therapy
OTO - NOTNLM
OT  - *Bladder
OT  - *Cancer
OT  - *Chemotherapy
OT  - *Induction
OT  - *Neoadjuvant
OT  - *Survival
EDAT- 2016/11/05 06:00
MHDA- 2017/08/02 06:00
CRDT- 2016/11/05 06:00
PHST- 2016/05/03 00:00 [received]
PHST- 2016/09/01 00:00 [revised]
PHST- 2016/09/13 00:00 [accepted]
PHST- 2016/11/05 06:00 [pubmed]
PHST- 2017/08/02 06:00 [medline]
PHST- 2016/11/05 06:00 [entrez]
AID - S0959-8049(16)32446-7 [pii]
AID - 10.1016/j.ejca.2016.09.015 [doi]
PST - ppublish
SO  - Eur J Cancer. 2016 Dec;69:1-8. doi: 10.1016/j.ejca.2016.09.015. Epub 2016 Oct 27.