Institute of Oncology, Vilnius University, Santariskiu 1, 08660 Vilnius, Lithuania.
Medicina (Kaunas). 2010;46(5):305-14.
The aim of the study was to evaluate the value of clinical prognostic factors for survival of patients with invasive urinary bladder cancer treated with radical cystectomy, chemotherapy, and radiotherapy.
A total of 115 patients with invasive urinary bladder cancer were analyzed. Twenty-three patients with invasive urinary bladder cancer (pT2-T4) were treated according to the protocol of a prospective clinical study. In all the cases, transurethral resection was followed by radiation and chemotherapy. A total dose of 54-60 Gy of radiotherapy was delivered by daily fractions of 1.8-2.0 Gy each. Simultaneous chemotherapy was started on the same day as radiotherapy; gemcitabine at a dose of 175-300 mg/m(2) was delivered once a week intravenously for 6 weeks. Individual patient data was analyzed in a retrospective part of the study. Radical cystectomy was performed to 46 patients with invasive urinary bladder cancer, and radiotherapy was delivered to 46 patients. Inclusion criteria for patients into a prospective or retrospective trial were equal. We evaluated a prognostic value of various clinical factors for patients treated with radical cystectomy, chemoradiation with gemcitabine, and radiation alone.
The 3-year overall survival in the cystectomy group was 51.1%, in the chemoradiation group 38.0%, and in the radiotherapy group 26.9% (P=0.001). In univariate analysis in the chemoradiation group, completion of treatment according to the protocol showed a significant influence on overall survival (P=0.03). In the radiation group, completion of treatment according to the protocol showed a significant influence on overall survival too (P=0.01). In the radical cystectomy group, an important factor was a complete or incomplete TUR (P=0.02). Multivariate analysis showed a significance of hydronephrosis (P=0.03) and T stage (P=0.04) in the radiation therapy group. Comorbidity was found to be an independent prognostic factors in the chemoradiation group (P=0.02).
The best 3-year overall survival was in the radical cystectomy group. Chemoradiation with gemcitabine could be offered as an alternative to patients refusing cystectomy. Better overall survival in the chemoradiation group was for patients without comorbidities and when treatment protocol was completed.
评估根治性膀胱切除术、化疗和放疗治疗浸润性膀胱癌患者的临床预后因素的价值。
分析了 115 例浸润性膀胱癌患者。23 例浸润性膀胱癌（pT2-T4）患者按前瞻性临床研究方案进行治疗。所有患者均行经尿道膀胱肿瘤切除术，然后行放疗和化疗。放疗总剂量为 54-60 Gy，每日分割 1.8-2.0 Gy。同步化疗于放疗同日开始；吉西他滨剂量为 175-300 mg/m2，每周静脉注射一次，共 6 周。对研究的回顾性部分中的个体患者数据进行分析。46 例浸润性膀胱癌患者行根治性膀胱切除术，46 例患者行放疗。前瞻性或回顾性试验中患者纳入标准相同。我们评估了各种临床因素对接受根治性膀胱切除术、吉西他滨放化疗和单纯放疗患者的预后价值。
根治性膀胱切除术组 3 年总生存率为 51.1%，放化疗组为 38.0%，放疗组为 26.9%（P=0.001）。在放化疗组的单因素分析中，按方案完成治疗对总生存率有显著影响（P=0.03）。在放疗组中，按方案完成治疗对总生存率也有显著影响（P=0.01）。在根治性膀胱切除术组中，重要因素是完全或不完全 TUR（P=0.02）。多因素分析显示，放疗组中存在积水（P=0.03）和 T 分期（P=0.04）是独立预后因素。在放化疗组中，合并症是独立的预后因素（P=0.02）。
根治性膀胱切除术组的 3 年总生存率最佳。对于拒绝膀胱切除术的患者，吉西他滨放化疗可作为替代方案。放化疗组中无合并症且按方案完成治疗的患者总生存率更好。
