Department of Urology, The University of Texas, M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Urol Oncol. 2011 Mar-Apr;29(2):157-61. doi: 10.1016/j.urolonc.2009.12.015. Epub 2010 Apr 24.
Patients with clinical T4b bladder cancer (extension to pelvic wall and/or adjacent organs other than prostate, vagina, or uterus) are commonly considered unresectable. We hypothesized that select patients might achieve durable benefit from multiagent chemotherapy and extirpative surgery.
We identified patients with clinical T4bN0 bladder cancer from our IRB-approved database of patients undergoing radical cystectomy (n = 1,194). Relevant demographic, clinical, and pathologic data were compiled. Overall (OS), disease-specific (DSS), and recurrence-free survival (RFS) were analyzed by Kaplan-Meier estimation. Cox proportional hazards regression modeling was used to evaluate the influence of several potential prognostic factors.
Twenty-three patients (16 male) with a median age of 65 years met study criteria. Chemotherapy was administered preoperatively to 19 (83%) and postoperatively to 8 (35%) patients. Eight patients died of disease and 1 of other causes. The 1-, 2-, and 5-year DSS was 91% (95% C.I. 70%-98%), 66% (95% C.I. 42%-83%), and 60% (95% C.I. 34%-78%), respectively. Eight of 17 patients with pT2-4 tumors succumbed to disease compared with none of 6 who were ≤ pT1 (P = 0.04). Other predictors of decreased DSS included positive surgical margins (HR = 5.34, 95% C.I. 1.25-22.83) and presence of pathologic nodal metastasis (HR = 29.33, 95% C.I. 3.13-275.19). Variant histology was more common in this cohort than in the overall cystectomy database (43% vs. 11%).
Long-term survival can be achieved in a proportion of patients with cT4b bladder cancer undergoing chemotherapy and extirpative surgery. Careful selection of patients and meticulous surgical technique to avoid positive margins are critical.
患有临床 T4b 膀胱癌（扩展至骨盆壁和/或前列腺、阴道或子宫以外的相邻器官）的患者通常被认为无法切除。我们假设选择的患者可能会从多药化疗和根治性手术中获得持久的益处。
我们从接受根治性膀胱切除术的患者的 IRB 批准的数据库中确定了患有临床 T4bN0 膀胱癌的患者（n=1194）。收集了相关的人口统计学、临床和病理数据。通过 Kaplan-Meier 估计分析总生存期（OS）、疾病特异性生存期（DSS）和无复发生存期（RFS）。使用 Cox 比例风险回归模型评估了几个潜在预后因素的影响。
23 名患者（16 名男性）中位年龄为 65 岁，符合研究标准。19 名（83%）患者接受术前化疗，8 名（35%）患者接受术后化疗。8 名患者死于疾病，1 名死于其他原因。1、2 和 5 年的 DSS 分别为 91%（95%置信区间 70%-98%）、66%（95%置信区间 42%-83%）和 60%（95%置信区间 34%-78%）。与 6 名≤pT1 的患者相比，17 名 pT2-4 肿瘤患者中有 8 名死于疾病（P=0.04）。DSS 降低的其他预测因素包括阳性手术切缘（HR=5.34，95%置信区间 1.25-22.83）和存在病理淋巴结转移（HR=29.33，95%置信区间 3.13-275.19）。与整个膀胱切除术数据库相比，该队列中变异型组织学更为常见（43%比 11%）。
在接受化疗和根治性手术的一部分 T4b 膀胱癌患者中，可以实现长期生存。仔细选择患者和精心的手术技术以避免阳性切缘至关重要。
