Departments of Urologic Oncology, Medical Oncology and Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA.
BJU Int. 2011 Jan;107(1):58-62. doi: 10.1111/j.1464-410X.2010.09442.x.
To evaluate the clinicopathological outcomes for patients with clinical T2 (cT2) urothelial carcinoma treated with radical cystectomy (RC) without neoadjuvant chemotherapy (NC).
We identified 212 patients with cT2 tumours who underwent RC at our institution without NC. Pathological assessment of RC specimens was correlated with clinical stage. The impact of various clinicopathological factors on the outcome of patients with cT2 disease was analysed.
In total, 153/212 (73.2%) patients with cT2 bladder cancer had either pT3/T4 or pN+ tumours at RC. Moreover, only 58/153 (37.9%) of these patients received adjuvant chemotherapy. The median follow-up was 28 (months 0.6-107.5) (range). The 5-year recurrence-free survival and cancer-specific survival (CSS) was 56.5% and 59.5%, respectively. On multivariate analysis, increasing age (hazard ratio [HR] 1.04; P= 0.04), advanced pathological stage (HR 1.83; P= 0.02), and positive lymph nodes (HR 3.72; P= 0.001) were adversely associated with CSS, while receipt of adjuvant chemotherapy was protective of disease-specific mortality (HR 0.45; P= 0.04).
Pathological upstaging is prevalent and survival remains modest in patients with cT2 tumours treated with RC without NC. Unfortunately, only 40% of patients that had locally advanced and/or regionally metastatic disease received adjuvant treatment. These data further support the value of NC for patients with muscle-invasive bladder cancer, even in those with apparent clinically organ-confined tumours.
评估未接受新辅助化疗（NC）的根治性膀胱切除术（RC）治疗的临床 T2（cT2）尿路上皮癌患者的临床病理结局。
我们在本机构中确定了 212 例接受 RC 而未接受 NC 的 cT2 肿瘤患者。RC 标本的病理评估与临床分期相关。分析各种临床病理因素对 cT2 疾病患者结局的影响。
总共，212 例 cT2 膀胱癌患者中有 153 例（73.2%）在 RC 时存在 pT3/T4 或 pN+肿瘤。此外，这些患者中仅有 58 例（37.9%）接受了辅助化疗。中位随访时间为 28 个月（0.6-107.5 个月）。5 年无复发生存率和癌症特异性生存率（CSS）分别为 56.5%和 59.5%。多因素分析显示，年龄增加（风险比[HR]1.04；P=0.04）、病理分期进展（HR1.83；P=0.02）和阳性淋巴结（HR3.72；P=0.001）与 CSS 呈负相关，而接受辅助化疗可降低疾病特异性死亡率（HR0.45；P=0.04）。
RC 治疗的 cT2 肿瘤患者中存在普遍的病理升级，生存情况仍较差。不幸的是，仅有 40%的局部晚期和/或区域转移疾病患者接受了辅助治疗。这些数据进一步支持了 NC 对肌层浸润性膀胱癌患者的价值，即使对于那些具有明显临床局限性肿瘤的患者也是如此。
